Provider Demographics
NPI:1104934058
Name:OVERDYK, FRANK J (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:OVERDYK
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 1:9263 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7109
Mailing Address - Country:US
Mailing Address - Phone:843-576-6168
Mailing Address - Fax:
Practice Address - Street 1:9263 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7109
Practice Address - Country:US
Practice Address - Phone:843-576-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264677207L00000X
SC17144207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC171441Medicaid
SC171441Medicaid
SCF87903Medicare ID - Type Unspecified