Provider Demographics
NPI:1417923731
Name:HERRIOTT, GEORGE E III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:HERRIOTT
Suffix:III
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 1:1600 MURDOCH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3248
Mailing Address - Country:US
Mailing Address - Phone:304-485-8040
Mailing Address - Fax:304-485-4883
Practice Address - Street 1:1600 MURDOCH AVE
Practice Address - Street 2:STE 100
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3248
Practice Address - Country:US
Practice Address - Phone:304-485-8040
Practice Address - Fax:304-485-4883
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2005883-000Medicaid
HE4118281Medicare ID - Type Unspecified
WV2005883-000Medicaid