Healthcare Provider Details

I. General information

NPI: 1598774879
Provider Name (Legal Business Name): ANNE E COSGROVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E 44TH ST
TACOMA WA
98404-4611
US

IV. Provider business mailing address

1019 PACIFIC AVE 300
TACOMA WA
98402-4443
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-4553
  • Fax: 253-474-5395
Mailing address:
  • Phone: 253-722-1540
  • Fax: 253-722-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00036407
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: