MEDICARE: TERRENCE A CRONIN MD FACD CHO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0019430	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	072886578	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	142306686	OTHER	FL	CHAMPUS
2	05291	OTHER	FL	BLUE SHIELD

General Provider Information

NPI Number	:	1003095746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRENCE A CRONIN MD FACD CHO

Provider Business Mailing Address
First Line	:	1399 S HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3208
Country	:	US
Telephone Number	:	321-726-1711
Fax Number	:	321-726-1715

Provider Business Practice Location Address
First Line	:	1399 S HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3208
Country	:	US
Telephone Number	:	321-726-1711
Fax Number	:	321-726-1715

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MEGAN M CRONIN
Credential	:	MD
Telephone Number	:	321-726-1711

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	11/13/2024

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