Healthcare Provider Details

I. General information

NPI: 1174475081
Provider Name (Legal Business Name): INNOVATECHCONNECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17052 BEVERIDGE DR
DUMFRIES VA
22026-2774
US

IV. Provider business mailing address

17052 BEVERIDGE DR
DUMFRIES VA
22026-2774
US

V. Phone/Fax

Practice location:
  • Phone: 317-835-9055
  • Fax:
Mailing address:
  • Phone: 317-835-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SYED NAJAM UL HASSAN
Title or Position: OWNER
Credential:
Phone: 317-835-9055