49D1059408 CLIA NUMBER - MILLENNIUM MEDICAL CORP DBA MILLENNIUM MEDICAL CARE

Laboratory Demographics

  • CLIA Code: 49D1059408
  • Facility Name: MILLENNIUM MEDICAL CORP DBA MILLENNIUM MEDICAL CARE
  • Facility Address: 6356 HOADLY ROAD
    MANASSAS, VA
    ZIP 20112
  • Facility Phone: 703 590-5999
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: REENA R. BOMMASANI
  • NPI Number: 1740443183
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D1059408
LAB Type Physician Office
Facility Name MILLENNIUM MEDICAL CORP DBA MILLENNIUM MEDICAL CARE
Street 6356 HOADLY ROAD
City MANASSAS
State VA
ZIP 20112
Phone 703 590-5999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2024
Certificate Expiration Date 9/27/2026
Facility Type Physician Office
Lab Director REENA R. BOMMASANI

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This page was last updated on: 9/29/2025