Provider Demographics
NPI:1720182108
Name:CRONIN, PATRICIA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:CRONIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NORTH BROADWELL AVE.
Mailing Address - Street 2:VA NEBRASKA-WESTERN IOWA HEALTH CARE SYSTEM
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803
Mailing Address - Country:US
Mailing Address - Phone:866-580-1810
Mailing Address - Fax:
Practice Address - Street 1:4 SHAWS CV FL 1
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4956
Practice Address - Country:US
Practice Address - Phone:860-437-3611
Practice Address - Fax:860-437-1801
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203965611Medicaid
MOD74588Medicare UPIN
MO000095097Medicare ID - Type UnspecifiedMEDICARE