Provider Demographics
NPI:1780672667
Name:CRONAN, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:CRONAN
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 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI59272085R0202X
RIMD059272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000543OtherBLUECHIPSENIORS
1600203OtherUNITEDHEALTHPLANS
240089OtherRIHPILGRIM
003117323OtherCT MED ASSISTANCE
240167OtherW AND I PILGRIM
7000466OtherRIMEDICALASSISTANCE
050318025OtherUNICARE
3200540OtherHEALTHYSTART
007000446OtherHOSPTIALPIN
5927OtherFEPBLUECROSS
6192076OtherMASSMEDICAID
005927OtherTUFTS
000000001988OtherNHPRI
000543OtherBLUECHIP
005927OtherBLUESHIELD
720051301OtherCIGNA