Provider Demographics
NPI:1538113279
Name:PIKE, CASSANDRA WATERS (DPM)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:WATERS
Last Name:PIKE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:CASSANDRA
Other - Middle Name:LOUIS
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:269 N GROVE MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4222
Mailing Address - Country:US
Mailing Address - Phone:864-586-3131
Mailing Address - Fax:864-586-3200
Practice Address - Street 1:269 N GROVE MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4222
Practice Address - Country:US
Practice Address - Phone:864-586-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000884213E00000X
SC535213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9955Medicaid
SC6626Medicare ID - Type Unspecified
U78131Medicare UPIN