Provider Demographics
NPI:1578723037
Name:KASSAMO DAYEMO,M.D.PA
Entity Type:Organization
Organization Name:KASSAMO DAYEMO,M.D.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KASSAMO
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:DAYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-763-0503
Mailing Address - Street 1:PO BOX 80631
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-0631
Mailing Address - Country:US
Mailing Address - Phone:843-763-0503
Mailing Address - Fax:843-763-0514
Practice Address - Street 1:1606 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5902
Practice Address - Country:US
Practice Address - Phone:843-763-0503
Practice Address - Fax:843-763-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF736810281Medicare PIN