Provider Demographics
NPI:1043258643
Name:CUSHNYR, BRAD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:WILLIAM
Last Name:CUSHNYR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26035
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON, INC
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-6035
Mailing Address - Country:US
Mailing Address - Phone:330-493-0840
Mailing Address - Fax:330-493-7123
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON, INC - ATTN: CECILIA
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-2842
Practice Address - Fax:330-580-5536
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010880202085R0202X
OH35-0824262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00423245OtherRAILROAD MEDICARE
OH2764549Medicaid
OH2764549Medicaid
OHI52900Medicare UPIN