Provider Demographics
NPI:1356702278
Name:MCCRONE, MICHELLE PATRICE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PATRICE
Last Name:MCCRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3105
Mailing Address - Country:US
Mailing Address - Phone:410-725-4793
Mailing Address - Fax:
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:DIVISION OF PEDIATRIC - MEDICAL GENETICS AND GENOMICS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:267-590-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-20
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT227973207SG0201X
NY297802208000000X
IL125.068373208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297802OtherPHYSICIAN LICENSE