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NPI Code Detail

MEDICARE: PRIVIA MEDICAL GROUP, LLC

MEDICARE: PRIVIA MEDICAL GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician

General Provider Information

NPI Number : 1053173443
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIVIA MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : 950 N GLEBE RD STE 700
Second Line :
City : ARLINGTON
State : VA
Zip : 22203-4173
Country : US
Telephone Number : 571-982-6636
Fax Number :
Provider Business Practice Location Address
First Line : 2415 MUSGROVE RD STE 203
Second Line :
City : SILVER SPRING
State : MD
Zip : 20904-5228
Country : US
Telephone Number : 301-989-2300
Fax Number :
Authorized Official
Title or Position : ENROLLMENT MANAGER
Name : MARIA GABBAI
Credential :
Telephone Number : 484-569-9066
Provider Enumeration Date : 01/30/2024
Last Update Date : 01/30/2024

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Directions to “PRIVIA MEDICAL GROUP, LLC ” Practice Location

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