Provider Demographics
NPI:1649386988
Name:COSGROVE, GARTH REES (MD, FRCSC)
Entity Type:Individual
Prefix:DR
First Name:GARTH
Middle Name:REES
Last Name:COSGROVE
Suffix:
Gender:M
Credentials:MD, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS STREET
Mailing Address - Street 2:BRIGHAM AND WOMAN'S HOSPITAL-NEUROSURGERY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-6858
Mailing Address - Fax:617-264-6835
Practice Address - Street 1:75 FRANCIS STREET
Practice Address - Street 2:BRIGHAM AND WOMAN'S HOSPITAL-NEUROSURGERY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6858
Practice Address - Fax:617-264-6835
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56191207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3008363Medicaid
MA3008363Medicaid
MA3008363Medicaid