Healthcare Provider Details

I. General information

NPI: 1750873618
Provider Name (Legal Business Name): BENJAMIN ANDREW CASOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 RIVERS AVE STE 100
NORTH CHARLESTON SC
29406-4809
US

IV. Provider business mailing address

11945 GRANDHAVEN DR STE E
MURRELLS INLET SC
29576-8091
US

V. Phone/Fax

Practice location:
  • Phone: 845-590-4873
  • Fax:
Mailing address:
  • Phone: 843-995-9025
  • Fax: 843-310-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number87780
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: