Provider Demographics
NPI:1821103714
Name:CRONIN, MATTHEW VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:VINCENT
Last Name:CRONIN
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:PO BOX 5789
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-5789
Mailing Address - Country:US
Mailing Address - Phone:800-318-5578
Mailing Address - Fax:903-663-7394
Practice Address - Street 1:3801 DEBARR ROAD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-276-1131
Practice Address - Fax:903-663-7394
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1080922085R0202X, 2085R0204X
FLME1122502085R0204X
AK1048232085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1648901Medicaid
CA00A1080920OtherBS OF CA
CA00A1080920OtherBS OF CA
CACB232219Medicare PIN
CA1821103714Medicaid