Provider Demographics
NPI:1336125525
Name:HERLIHY-RAYLA, DIANE L (CNM)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:HERLIHY-RAYLA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:L HERLIHY
Other - Last Name:RAYLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-368-3110
Mailing Address - Fax:508-368-3113
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1312
Practice Address - Country:US
Practice Address - Phone:508-368-3110
Practice Address - Fax:508-368-3113
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128722367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
61225OtherFALLON COMMUNITY HEALTH P
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
CN0159OtherBLUE SHIELD INDEMNITY
MA0380920Medicaid
2731108OtherCIGNA HEALTH PLAN
420000550OtherRAILROAD MEDICARE
43919OtherCHILDRENS MEDICAL SECURIT
43919OtherHEALTHY START
CN0159OtherBLUE CARE ELECT
7806647OtherAETNA/US HEALTHCARE
AA3614OtherHARVARD PILGRIM HEALTHCAR
CN0159OtherBLUE SHIELD HMO BLUE
RN0016OtherMEDICARE B
0380920OtherMEDICAID/WELFARE
CN0159OtherBLUE CARE ELECT
CN0159OtherBLUE SHIELD HMO BLUE