Healthcare Provider Details

I. General information

NPI: 1679992382
Provider Name (Legal Business Name): BRIAN CRONIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 EMBASSY DR
LANCASTER PA
17603-2387
US

IV. Provider business mailing address

2101 EMBASSY DR
LANCASTER PA
17603-2387
US

V. Phone/Fax

Practice location:
  • Phone: 717-735-7410
  • Fax:
Mailing address:
  • Phone: 717-735-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberFC8331605
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberOS021595
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: