Healthcare Provider Details

I. General information

NPI: 1982166716
Provider Name (Legal Business Name): MATTHEW J KASSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 ASHLEY AVE
CHARLESTON SC
29425-8908
US

IV. Provider business mailing address

PO BOX 601743
CHARLOTTE NC
28260-1743
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2300
  • Fax:
Mailing address:
  • Phone: 843-777-7555
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number91840
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: