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NPI Code Detail

MEDICARE: KASSAMO DAYEMO,M.D.PA

MEDICARE: KASSAMO DAYEMO,M.D.PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician19094SC

General Provider Information

NPI Number : 1578723037
Entity Type Code : Organization
Provider Name (Legal Business Name) : KASSAMO DAYEMO,M.D.PA
Provider Business Mailing Address
First Line : PO BOX 80631
Second Line :
City : CHARLESTON
State : SC
Zip : 29416-0631
Country : US
Telephone Number : 843-763-0503
Fax Number : 843-763-0514
Provider Business Practice Location Address
First Line : 1606 ASHLEY RIVER RD
Second Line :
City : CHARLESTON
State : SC
Zip : 29407-5902
Country : US
Telephone Number : 843-763-0503
Fax Number : 843-763-0514
Authorized Official
Title or Position : PRESIDENT
Name : DR. KASSAMO N/A DAYEMO
Credential : MD
Telephone Number : 843-763-0503
Provider Enumeration Date : 06/09/2008
Last Update Date : 06/09/2008

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