MEDICARE: NOVA DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1154263663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	12011 ROUTE 50 STE 205
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-3323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12011 ROUTE 50 STE 205
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-3323
Country	:	US
Telephone Number	:	866-324-9804
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROY WATSON
Credential	:
Telephone Number	:	866-324-9804

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/07/2026

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Directions to “NOVA DIAGNOSTICS LLC ” Practice Location

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