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
8988 LORTON STATION BLVD STE 100, LORTON, VA 22079-4757
(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
207R00000X
Internal Medicine Physician
Primary
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7442750009
DME
—
Enumeration date
09/26/2019
Last updated
03/05/2020
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