Individual
MR. MALCOLM DAVID COSGROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16311 VENTURA BLVD, STE 1000, ENCINO, CA 91436-2147
(818) 906-0635
(818) 906-7303
Mailing address
16311 VENTURA BLVD, STE 1000, ENCINO, CA 91436-2147
(818) 906-0635
(818) 906-7303
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A25183
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A251830
—
CA
01
—
P00647436
RAILROAD MEDICARE PTAN
CA
01
—
Z22046856Z
BLUE SHIELD
CA
Enumeration date
11/09/2005
Last updated
02/11/2009
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