Provider Demographics
NPI:1538742671
Name:DANIEL S COSGROVE, MD, PC
Entity type:Organization
Organization Name:DANIEL S COSGROVE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-777-7698
Mailing Address - Street 1:45200 CLUB DR STE A
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:CA
Mailing Address - Zip Code:92210-8837
Mailing Address - Country:US
Mailing Address - Phone:760-777-7698
Mailing Address - Fax:760-477-6002
Practice Address - Street 1:45200 CLUB DR STE A
Practice Address - Street 2:
Practice Address - City:INDIAN WELLS
Practice Address - State:CA
Practice Address - Zip Code:92210-8837
Practice Address - Country:US
Practice Address - Phone:760-777-7698
Practice Address - Fax:760-477-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty