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General NPI Number Information
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NPI Number | 1659183788
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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 | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 1635 N GEORGE MASON DR STE 180
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City | ARLINGTON
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State | VA
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Zip | 22205-3633
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Country | US
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Telephone | 703-718-4828
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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 | 800-973-1442
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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 | 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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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