Provider Demographics
NPI:1174721864
Name:CRONIN, TARA H (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:H
Last Name:CRONIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1201 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3105
Mailing Address - Country:US
Mailing Address - Phone:203-597-9100
Mailing Address - Fax:203-573-4805
Practice Address - Street 1:1201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3105
Practice Address - Country:US
Practice Address - Phone:203-573-4885
Practice Address - Fax:203-401-6517
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT047744207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400003709OtherMEDICARE