Provider Demographics
NPI:1003095746
Name:TERRENCE A CRONIN SR, M.D.,FACD CHO
Entity Type:Organization
Organization Name:TERRENCE A CRONIN SR, M.D.,FACD CHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:321-726-1711
Mailing Address - Street 1:1399 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3208
Mailing Address - Country:US
Mailing Address - Phone:321-726-1711
Mailing Address - Fax:321-726-1715
Practice Address - Street 1:1399 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3208
Practice Address - Country:US
Practice Address - Phone:321-726-1711
Practice Address - Fax:321-726-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019430174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL072886578OtherRAILROAD MEDICARE
FL142306686OtherCHAMPUS
FL05291OtherBLUE SHIELD
FL142306686OtherCHAMPUS
FLD51223Medicare UPIN