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General NPI Number Information
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NPI Number | 1457795155
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Entity Type | Individual
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Provider Name | BRANDON SLACK RADOW M.D,
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Gender | Male
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 3100 MACCORKLE AVE SE STE 700
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City | CHARLESTON
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State | WV
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Zip | 25304-1230
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Country | US
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Telephone | 304-351-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-7238
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35.139935
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18124
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License Number State | NV
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