Provider Demographics
NPI:1548262140
Name:CRONIN, TERRENCE ALLAN SR (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:ALLAN
Last Name:CRONIN
Suffix:SR
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 1:1399 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:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019430207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05291OtherFLORIDA BLUE SHIELD
FL05291OtherFLORIDA BLUE SHIELD
FLD51223Medicare UPIN