Provider Demographics
NPI:1912352931
Name:THIEROFF, GEORGE VIEWEG III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:VIEWEG
Last Name:THIEROFF
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 1:1101 E MARSHALL ST # 980663
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5048
Mailing Address - Country:US
Mailing Address - Phone:804-828-9357
Mailing Address - Fax:804-828-8660
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:BOX 980163
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-9357
Practice Address - Fax:804-828-5466
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101269922207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program