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:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
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:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010880202085R0202X
OH35-0824262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2764549Medicaid
OHP00423245OtherRAILROAD MEDICARE
OH2764549Medicaid
OHI52900Medicare UPIN