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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1447012539
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	:	3430 WORTHINGTON BLVD STE 103
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7018
Country	:	US
Telephone Number	:	301-845-6336
Fax Number	:	240-578-4478

Authorized Official
Title or Position	:	AVP CRED AND ENROLLMENT
Name	:	BRIANNA FOULKROD
Credential	:
Telephone Number	:	571-650-2710

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	04/18/2026

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