Privia Medical Group, LLC
Internal Medicine in Lorton, VA. Organization (NPI-2).
NPI number1962053306
StatusActive
Last updated in NPPESMar 5, 2020
Details
- NPI
- 1962053306
- Entity type
- Organization (NPI-2)
- Legal business name
- Privia Medical Group, LLC
- Organization subpart
- No
- Enumeration date
- Sep 26, 2019
- Certification date
- Mar 5, 2020
- Last updated
- Mar 5, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
| 213E00000X | Podiatrist | – | – |
Other names
- Mount Vernon Internal Medicine (Doing Business As)
Practice location
8988 Lorton Station Blvd Ste 100Lorton, VA 22079-4757
Phone 571-366-8850
Mailing address
950 N Glebe Rd Ste 700Arlington, VA 22203-4173
Phone 571-366-8850
Authorized official
Courtney Ainsworth Ivess
Associate Director, Credentialing
5713668831
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Other Internal Medicine Physician providers in Lorton, VA
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