Provider Demographics
NPI:1457322059
Name:GAME, DANIEL KASSAYE (M D)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KASSAYE
Last Name:GAME
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80054
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-0054
Mailing Address - Country:US
Mailing Address - Phone:843-766-6646
Mailing Address - Fax:843-766-6640
Practice Address - Street 1:1866 RAOUL WALLENBERG BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3545
Practice Address - Country:US
Practice Address - Phone:843-766-6646
Practice Address - Fax:843-766-6646
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22070207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC290013912OtherMEDICARE ID-TYPE UNSPECIFIED/MEDICARE(RAILROAD)
SCGP3435Medicaid
SC290013912OtherMEDICARE ID-TYPE UNSPECIFIED/MEDICARE(RAILROAD)
SCGP3435Medicaid