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General NPI Number Information
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NPI Number | 1578723037
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Entity Type | Organization
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Legal Business Name | KASSAMO DAYEMO,M.D.PA
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 1606 ASHLEY RIVER RD
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City | CHARLESTON
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State | SC
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Zip | 29407-5902
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Country | US
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Telephone | 843-763-0503
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Fax | 843-763-0514
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Provider Business Mailing Address
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Address Line | PO BOX 80631
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City | CHARLESTON
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State | SC
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Zip | 29416-0631
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Country | US
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Telephone | 843-763-0503
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Fax | 843-763-0514
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KASSAMO N/A DAYEMO
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Credential | MD
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Telephone | 843-763-0503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 19094
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License Number State | SC
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