Provider Demographics
NPI:1639137920
Name:ROCCO D. CASSONE MD PA
Entity Type:Organization
Organization Name:ROCCO D. CASSONE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:D
Authorized Official - Last Name:CASSONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-536-5511
Mailing Address - Street 1:832 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:803-536-5511
Mailing Address - Fax:803-536-0636
Practice Address - Street 1:1175 COOK RD
Practice Address - Street 2:SUITE 230
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8201
Practice Address - Country:US
Practice Address - Phone:803-536-5511
Practice Address - Fax:803-536-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA2835Medicaid
SC2022Medicare PIN