Provider Demographics
NPI:1669470126
Name:TALBOT, GEORGE THEODORE III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:THEODORE
Last Name:TALBOT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8051 S EMERSON AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8633
Mailing Address - Country:US
Mailing Address - Phone:317-865-3600
Mailing Address - Fax:317-885-3850
Practice Address - Street 1:1205 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1737
Practice Address - Country:US
Practice Address - Phone:317-584-3454
Practice Address - Fax:317-584-3435
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-072719207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2015938Medicaid
OH2015938Medicaid
OHG61272Medicare UPIN
OHG61272Medicare UPIN