MEDICARE: INNOVATECHCONNECT 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1174475081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATECHCONNECT LLC

Provider Business Mailing Address
First Line	:	17052 BEVERIDGE DR
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22026-2774
Country	:	US
Telephone Number	:	317-835-9055
Fax Number	:

Provider Business Practice Location Address
First Line	:	17052 BEVERIDGE DR
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22026-2774
Country	:	US
Telephone Number	:	317-835-9055
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SYED NAJAM UL HASSAN
Credential	:
Telephone Number	:	317-835-9055

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	06/17/2026

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