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General NPI Number Information
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NPI Number | 1710771035
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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 | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 9601 BLACKWELL RD STE 260
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City | ROCKVILLE
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State | MD
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Zip | 20850-6487
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Country | US
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Telephone | 301-610-0663
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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 | AUTHORIZED OFFICIAL
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Name | ALLISON HENNESSEY
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Credential |
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Telephone | 304-276-9254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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