Basic Information
Provider Information | |||||||||
NPI: | 1780672667 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRONAN | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
Address2: |   | ||||||||
City: | WARWICK | ||||||||
State: | RI | ||||||||
PostalCode: | 028861785 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4014322520 | ||||||||
FaxNumber: | 4014538220 | ||||||||
Practice Location | |||||||||
Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
Address2: |   | ||||||||
City: | WARWICK | ||||||||
State: | RI | ||||||||
PostalCode: | 028861785 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4014322520 | ||||||||
FaxNumber: | 4014538220 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/13/2005 | ||||||||
LastUpdateDate: | 03/19/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 5927 | RI | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD05927 | RI | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 000543 | 01 |   | BLUECHIPSENIORS | OTHER | 1600203 | 01 |   | UNITEDHEALTHPLANS | OTHER | 240089 | 01 |   | RIHPILGRIM | OTHER | 003117323 | 01 |   | CT MED ASSISTANCE | OTHER | 240167 | 01 |   | W AND I PILGRIM | OTHER | 7000466 | 01 |   | RIMEDICALASSISTANCE | OTHER | 050318025 | 01 |   | UNICARE | OTHER | 3200540 | 01 |   | HEALTHYSTART | OTHER | 007000446 | 01 |   | HOSPTIALPIN | OTHER | 5927 | 01 |   | FEPBLUECROSS | OTHER | 6192076 | 01 |   | MASSMEDICAID | OTHER | 005927 | 01 |   | TUFTS | OTHER | 000000001988 | 01 |   | NHPRI | OTHER | 000543 | 01 |   | BLUECHIP | OTHER | 005927 | 01 |   | BLUESHIELD | OTHER | 720051301 | 01 |   | CIGNA | OTHER |