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General NPI Number Information
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NPI Number | 1275356065
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Entity Type | Organization
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Legal Business Name | PRIVIA MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 6000 EXECUTIVE BLVD STE 312
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City | ROCKVILLE
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State | MD
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Zip | 20852-3803
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Country | US
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Telephone | 240-553-5003
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Fax |
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Provider Business Mailing Address
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Address Line | 950 N GLEBE RD STE 700
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City | ARLINGTON
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State | VA
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Zip | 22203-4173
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Country | US
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Telephone | 484-228-1065
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Fax |
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Authorized Official
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Title or Position | ENROLLMENT MANAGER
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Name | MARIA GABBAI
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Credential |
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Telephone | 484-569-9066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number |
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License Number State |
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