Healthcare Provider Details

I. General information

NPI: 1043258643
Provider Name (Legal Business Name): BRAD WILLIAM CUSHNYR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 6TH ST SW RADIOLOGY ASSOCIATES OF CANTON, INC - ATTN: CECILIA
CANTON OH
44710-1702
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-2842
  • Fax: 330-580-5536
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301088020
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35-082426
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: