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Organization
PRIVIA CARE CENTER LLC
Active
Organization
PRIVIA CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY AINSWORTH IVESS (ASSOCIATE DIRECTOR, CREDENTIALING)
(571) 366-8831
Entity
Organization
Contact information
Practice address
301 SAINT PAUL ST STE 409, BALTIMORE, MD 21202-2102
(571) 366-8850
Mailing address
950 N GLEBE RD STE 4000, ARLINGTON, VA 22203-1824
(157) 198-2663
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
10/02/2018
Last updated
10/02/2018
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