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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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner
2103T00000XPsychologist

General Provider Information

NPI Number : 1366236697
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 : 800-973-1442
Fax Number :
Provider Business Practice Location Address
First Line : 16 GREENMEADOW DR STE 302
Second Line :
City : TIMONIUM
State : MD
Zip : 21093-3200
Country : US
Telephone Number : 443-449-5604
Fax Number :
Authorized Official
Title or Position : AVP CREDENTIALING & ENROLLMENT
Name : BRIANNA FOULKROD
Credential :
Telephone Number : 571-650-2710
Provider Enumeration Date : 04/09/2025
Last Update Date : 01/27/2026

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