Basic Information
| Provider Information | |||||||||
| NPI: | 1770055238 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIVIA WOMENS HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 N GLEBE RD STE 4000 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222031824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5713668850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7611 FOREST AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232294946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5713668850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2018 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | IVESS | ||||||||
| AuthorizedOfficialFirstName: | COURTNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR, CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5713668831 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VX0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207VF0040X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | 207VG0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.