Basic Information
| Provider Information | |||||||||
| NPI: | 1346200607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRIEST | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046974497 | ||||||||
| FaxNumber: | 3045239470 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046974497 | ||||||||
| FaxNumber: | 3045239470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 03/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 13190 | WV | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0101686000 | 05 | WV | MEDICAID | 64697113 | 05 | KY | MEDICAID | 0525837 | 05 | OH | MEDICAID |