Provider Demographics
NPI:1144260928
Name:CRONKRIGHT, PETER J (MD38)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:CRONKRIGHT
Suffix:
Gender:M
Credentials:MD38
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-5240
Mailing Address - Fax:315-464-3892
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-5240
Practice Address - Fax:315-464-3892
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00973780Medicaid
NYCC2569Medicare PIN
NY00973780Medicaid