Healthcare Provider Details

I. General information

NPI: 1003095746
Provider Name (Legal Business Name): TERRENCE A CRONIN MD FACD CHO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 S HARBOR CITY BLVD
MELBOURNE FL
32901-3208
US

IV. Provider business mailing address

1399 S HARBOR CITY BLVD
MELBOURNE FL
32901-3208
US

V. Phone/Fax

Practice location:
  • Phone: 321-726-1711
  • Fax: 321-726-1715
Mailing address:
  • Phone: 321-726-1711
  • Fax: 321-726-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME0019430
License Number StateFL

VIII. Authorized Official

Name: DR. MEGAN M CRONIN
Title or Position: PRESIDENT
Credential: MD
Phone: 321-726-1711