Healthcare Provider Details

I. General information

NPI: 1861472946
Provider Name (Legal Business Name): DANUTA ANNA KASSUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 FOLLY RD SUITE 102
CHARLESTON SC
29412-2507
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-2323
  • Fax: 843-762-7629
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23669
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: