Basic Information
| Provider Information | |||||||||
| NPI: | 1821484882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OPALAK | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | FREDERICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 GROVE RD. | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644557000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 701 GROVE RD. | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644557000 | ||||||||
| FaxNumber: | 8647977155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2015 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207T00000X | 87499 | SC | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | SC | MEDICAID |