Healthcare Provider Details

I. General information

NPI: 1417923731
Provider Name (Legal Business Name): GEORGE E HERRIOTT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MURDOCH AVE STE 100
PARKERSBURG WV
26101-3248
US

IV. Provider business mailing address

1600 MURDOCH AVE SUITE 100
PARKERSBURG WV
26101-3248
US

V. Phone/Fax

Practice location:
  • Phone: 304-485-8040
  • Fax: 304-485-4883
Mailing address:
  • Phone: 304-485-8040
  • Fax: 304-485-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number18931
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: