Healthcare Provider Details

I. General information

NPI: 1063597151
Provider Name (Legal Business Name): DAVID J CHRONLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4979 TOWER HILL RD
WAKEFIELD RI
02879-2283
US

IV. Provider business mailing address

4979 TOWER HILL RD
WAKEFIELD RI
02879-2283
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-6492
  • Fax: 401-789-5524
Mailing address:
  • Phone: 401-789-6492
  • Fax: 401-789-5524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04859
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: