Healthcare Provider Details

I. General information

NPI: 1578723037
Provider Name (Legal Business Name): KASSAMO DAYEMO,M.D.PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 ASHLEY RIVER RD
CHARLESTON SC
29407-5902
US

IV. Provider business mailing address

PO BOX 80631
CHARLESTON SC
29416-0631
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-0503
  • Fax: 843-763-0514
Mailing address:
  • Phone: 843-763-0503
  • Fax: 843-763-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number19094
License Number StateSC

VIII. Authorized Official

Name: DR. KASSAMO N/A DAYEMO
Title or Position: PRESIDENT
Credential: MD
Phone: 843-763-0503