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General NPI Number Information
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NPI Number | 1437910932
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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 | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 5325 SPECTRUM DR
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City | FREDERICK
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State | MD
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Zip | 21703-7339
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Country | US
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Telephone | 240-651-3965
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Fax | 301-360-5320
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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 | 571-982-6636
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Fax | 240-696-1353
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT MANAGER
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Name | MARIA GABBAI
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Credential |
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Telephone | 610-530-4363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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