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General NPI Number Information
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NPI Number | 1710702873
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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 | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1 TEXAS STATION CT STE 300
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City | LUTHERVILLE TIMONIUM
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State | MD
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Zip | 21093-8289
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Country | US
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Telephone | 410-828-7417
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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