Provider Demographics
NPI:1861472946
Name:KASSUR, DANUTA ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANUTA
Middle Name:ANNA
Last Name:KASSUR
Suffix:
Gender:F
Credentials:MD
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 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:325 FOLLY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2507
Practice Address - Country:US
Practice Address - Phone:843-762-2323
Practice Address - Fax:843-762-7629
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23669207R00000X
OH35063423K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC236694Medicaid
OH0952616Medicaid
OH0952616Medicaid