NPIMap

Privia Medical Group, LLC

Organization Active NPI Family Medicine Physician · Brunswick, MD

NPI 1104688290 · NPPES record last updated Apr 18, 2026

Key facts

NPI
1104688290
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
PRIVIA MEDICAL GROUP, LLC
Practice address
610 9TH Ave
Brunswick, MD 21716-1828
Phone
(301) 834-7188
Fax
(240) 578-4476
NPI assigned
Jan 25, 2024
Organization subpart
No

Authorized official

Name
Brianna Foulkrod
Title
Avp Cred and Enrollment
Phone
(571) 650-2710

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Privia Medical Group LLC (381 organizations share this tax ID)

Locations

610 9th Ave
Brunswick, MD 21716
Phone (301) 834-7188

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

610 9TH Ave
Brunswick, MD 21716-1828

Mailing address

950 N Glebe Rd Ste 700
Arlington, VA 22203-4173
Phone (571) 982-6636

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 18, 2026.

{
    "created_epoch": "1706140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776470400000",
    "number": "1104688290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N GLEBE RD STE 700",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222034173",
            "telephone_number": "571-982-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 9TH AVE",
            "city": "BRUNSWICK",
            "state": "MD",
            "postal_code": "217161828",
            "telephone_number": "301-834-7188",
            "fax_number": "240-578-4476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-25",
        "last_updated": "2026-04-18",
        "certification_date": "2026-04-18",
        "status": "A",
        "authorized_official_last_name": "FOULKROD",
        "authorized_official_first_name": "BRIANNA",
        "authorized_official_title_or_position": "AVP CRED AND ENROLLMENT",
        "authorized_official_telephone_number": "571-650-2710"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, MD

All providers in Brunswick, MD · Family Medicine Physician in Maryland

Sources for this page

Verify at the official NPI Registry.