Organization
PRIVIA MEDICAL GROUP, LLC
Active
Other names
Mount Vernon Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY AINSWORTH IVESS (ASSOCIATE DIRECTOR, CREDENTIALING)
(571) 366-8831
Entity
Organization
Contact information
Practice address
6128 BRANDON AVE STE 201, SPRINGFIELD, VA 22150-2693
(571) 366-8850
Mailing address
950 N GLEBE RD STE 700, ARLINGTON, VA 22203-4173
(571) 366-8850
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7442750010
MEDICARE DME
VA
Enumeration date
09/26/2019
Last updated
03/11/2020
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