Provider Demographics
NPI:1922056332
Name:CASSONE, ROCCO DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:DOUGLAS
Last Name:CASSONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2126
Mailing Address - Country:US
Mailing Address - Phone:803-536-5511
Mailing Address - Fax:803-536-0636
Practice Address - Street 1:832 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2126
Practice Address - Country:US
Practice Address - Phone:803-536-5511
Practice Address - Fax:803-536-0636
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA2835Medicaid
SC2022Medicare ID - Type Unspecified