Provider Demographics
NPI:1265568398
Name:KRONMAN, BARRY STEWART (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:STEWART
Last Name:KRONMAN
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 1:1212 S RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3551
Mailing Address - Country:US
Mailing Address - Phone:321-676-2154
Mailing Address - Fax:321-726-8832
Practice Address - Street 1:1212 S RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3551
Practice Address - Country:US
Practice Address - Phone:321-676-2154
Practice Address - Fax:321-726-8832
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 19274207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51228Medicare UPIN
FL05299Medicare ID - Type Unspecified