=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629406806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTIMAL RADIOLOGY PARTNERS OF VIRGINIA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2013
-----------------------------------------------------
Last Update Date | 08/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 OPITZ BLVD
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22191-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-564-2611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 WHITE BRIDGE RD STE 111
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37205-1499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-564-2611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. CHAD L CALENDINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 330-564-2611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------