Basic Information
Provider Information
NPI: 1417126251
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRONIN
FirstName: BETH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 DUDLEY ST
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029052401
CountryCode: US
TelephoneNumber: 4012741122
FaxNumber:  
Practice Location
Address1: 101 DUDLEY ST
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029052401
CountryCode: US
TelephoneNumber: 4012741122
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/26/2008
LastUpdateDate: 05/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XMD13335RIY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home