Provider Demographics
NPI:1093820359
Name:COSGROVE, ANNETTE (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:COSGROVE
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 1:1022 1ST ST N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8706
Mailing Address - Country:US
Mailing Address - Phone:205-663-9550
Mailing Address - Fax:205-620-0864
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:SUITE 102
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8706
Practice Address - Country:US
Practice Address - Phone:205-663-9550
Practice Address - Fax:205-620-0864
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20665208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
510-49285OtherBCBSAL
510-65560OtherBCBSAL
AL000127520Medicaid
AL000111528Medicaid
F43015Medicare UPIN