Organization
PRIVIA MEDICAL GROUP, LLC
Active
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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