Healthcare Provider Details

I. General information

NPI: 1720084833
Provider Name (Legal Business Name): CLAIRE TINE CRONIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-8749
  • Fax: 617-421-2236
Mailing address:
  • Phone: 617-421-8749
  • Fax: 617-421-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number204344
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: