MEDICARE: VENZOMAT 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	:	1528883808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENZOMAT LLC

Provider Business Mailing Address
First Line	:	4201 EVERGREEN DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 EVERGREEN DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2721
Country	:	US
Telephone Number	:	703-798-2382
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMMED FAROOQ
Credential	:
Telephone Number	:	703-798-2382

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	06/03/2026

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Directions to “VENZOMAT LLC ” Practice Location

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