1780672667 NPI number — JOHN J CRONAN MD

Table of content: (NPI 1104990928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780672667 NPI number — JOHN J CRONAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRONAN
Provider First Name:
JOHN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780672667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 METRO CENTER BLVD STE 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-1785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-432-2520
Provider Business Mailing Address Fax Number:
401-453-8220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 METRO CENTER BLVD STE 2000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-1785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-432-2520
Provider Business Practice Location Address Fax Number:
401-453-8220
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  5927 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD05927 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000543 . This is a "BLUECHIPSENIORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1600203 . This is a "UNITEDHEALTHPLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240089 . This is a "RIHPILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003117323 . This is a "CT MED ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 240167 . This is a "W AND I PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7000466 . This is a "RIMEDICALASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050318025 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3200540 . This is a "HEALTHYSTART" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007000446 . This is a "HOSPTIALPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5927 . This is a "FEPBLUECROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6192076 . This is a "MASSMEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005927 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000001988 . This is a "NHPRI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000543 . This is a "BLUECHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005927 . This is a "BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 720051301 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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