Provider Demographics
NPI:1790575082
Name:PRIVIA MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:PRIVIA MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRONISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-789-2960
Mailing Address - Street 1:950 N GLEBE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-4173
Mailing Address - Country:US
Mailing Address - Phone:703-754-0425
Mailing Address - Fax:
Practice Address - Street 1:101 FLEET ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2309
Practice Address - Country:US
Practice Address - Phone:301-298-1040
Practice Address - Fax:240-847-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty