Provider Demographics
NPI:1760643399
Name:TELERAD EXPRESS, LLC
Entity Type:Organization
Organization Name:TELERAD EXPRESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-245-4181
Mailing Address - Street 1:23811 CHAGRIN BLVD
Mailing Address - Street 2:#114
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5525
Mailing Address - Country:US
Mailing Address - Phone:216-245-4190
Mailing Address - Fax:216-378-0035
Practice Address - Street 1:23811 CHAGRIN BLVD
Practice Address - Street 2:#114
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5525
Practice Address - Country:US
Practice Address - Phone:216-245-4190
Practice Address - Fax:216-378-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology