Provider Demographics
NPI:1639490915
Name:WASSUM, JOHN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:WASSUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8 MEMORIAL MEDICAL CT STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4400
Mailing Address - Country:US
Mailing Address - Phone:864-295-3492
Mailing Address - Fax:864-295-4817
Practice Address - Street 1:8 MEMORIAL MEDICAL CT STE 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4400
Practice Address - Country:US
Practice Address - Phone:864-295-3492
Practice Address - Fax:864-295-4817
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC32766LL207ZP0102X, 207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology