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General NPI Number Information
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NPI Number | 1891546321
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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 | 04/01/2024
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 19450 DEERFIELD AVE STE 335
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City | LEESBURG
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State | VA
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Zip | 20176-6822
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Country | US
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Telephone | 703-431-4145
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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 |
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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 | TRACEY J BAUGHEY
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Credential |
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Telephone | 267-981-6519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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