Provider Demographics
NPI:1356343115
Name:CRONIN, TERRENCE ALLAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:ALLAN
Last Name:CRONIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1399 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3208
Mailing Address - Country:US
Mailing Address - Phone:321-726-1711
Mailing Address - Fax:321-726-1715
Practice Address - Street 1:1399 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3208
Practice Address - Country:US
Practice Address - Phone:321-726-1711
Practice Address - Fax:321-726-1715
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066760207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26265OtherFLORIDA BLUE SHIELD
FL26265OtherMEDICARE
FL379600100Medicaid
6189190OtherCIGNA
FL18258OtherAETNA
FL070007155OtherRAILROAD MEDICARE
FL26265OtherFLORIDA BLUE SHIELD