NPIMap

Organization Active NPI

Tidewater Diagnostic Imaging LTD

  • Diagnostic Radiology Physician
  • Hampton, VA
National Provider Identifier
1073626396
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
TIDEWATER DIAGNOSTIC IMAGING LTD
Practice address
3000 Coliseum Dr
Hampton, VA 23666-5963
Phone
(757) 736-1621
Fax
(757) 512-5025
NPI assigned
Aug 17, 2006
Reactivated
Jan 11, 2019
Last updated
Aug 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ravi Shamaiengar, MD
Title
President
Phone
(757) 984-7911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

3000 Coliseum Dr
Hampton, VA 23666-5963

Mailing address

PO Box 844723
Boston, MA 02284-4723
Phone (866) 759-4524

National Provider Directory

National Provider Directory

Locations

11803 Jefferson Ave
Ste 130
Newport News, VA 23606
Phone (757) 594-1899

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1073626396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844723",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022844723",
            "telephone_number": "866-759-4524",
            "fax_number": "757-512-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 COLISEUM DR",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236665963",
            "telephone_number": "757-736-1621",
            "fax_number": "757-512-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER DIAGNOSTIC IMAGING LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "deactivation_date": "2019-01-08",
        "reactivation_date": "2019-01-11",
        "status": "A",
        "authorized_official_last_name": "SHAMAIENGAR",
        "authorized_official_first_name": "RAVI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-984-7911",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.