Provider Demographics
NPI:1699753475
Name:CRONIN, ELLEN E (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:CRONIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 E WEST HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4523
Mailing Address - Country:US
Mailing Address - Phone:301-907-3353
Mailing Address - Fax:301-907-8547
Practice Address - Street 1:4401 E WEST HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4523
Practice Address - Country:US
Practice Address - Phone:301-907-3353
Practice Address - Fax:301-907-8547
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00128052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21355Medicaid
MD21355Medicaid
MDLI173810Medicare ID - Type Unspecified