MEDICARE: PRIVYHEALTH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	2083P0901X	Public Health & General Preventive Medicine Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1245199157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVYHEALTH, LLC

Provider Business Mailing Address
First Line	:	2800 EISENHOWER AVE STE 220-B23
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-5204
Country	:	US
Telephone Number	:	703-424-9024
Fax Number	:	703-214-2955

Provider Business Practice Location Address
First Line	:	7918 JONES BRANCH DR FL 4
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3319
Country	:	US
Telephone Number	:	703-424-9024
Fax Number	:	703-214-2955

Authorized Official
Title or Position	:	OWNER
Name	:	ELDESIA GRANGER
Credential	:	MD
Telephone Number	:	703-296-4753

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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