=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720878325
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH ELIZABETH COSGROVE CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 LANSDOWNE AVE
-----------------------------------------------------
City | DARBY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19023-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-237-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 E WYNNEWOOD RD APT 11H
-----------------------------------------------------
City | WYNNEWOOD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19096-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-299-4587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | SP031961
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------