Provider Demographics
NPI:1295722890
Name:CRONIN, KATHLEEN T (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:MONUMENT BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02553
Mailing Address - Country:US
Mailing Address - Phone:508-517-9275
Mailing Address - Fax:
Practice Address - Street 1:16 BAYVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:MONUMENT BEACH
Practice Address - State:MA
Practice Address - Zip Code:02553
Practice Address - Country:US
Practice Address - Phone:508-517-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160748207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3207544Medicaid
MA110062498AMedicaid
RIKC57765Medicaid
MA110062498AMedicaid
MAA3109807Medicare PIN
MA3207544Medicaid