Provider Demographics
NPI:1437306602
Name:HERLIHY, JULIE MORIARTY (JULIE HERLIHY MD MPH)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MORIARTY
Last Name:HERLIHY
Suffix:
Gender:F
Credentials:JULIE HERLIHY MD MPH
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:HERLIHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JULIE HERLIHY MD MPH
Mailing Address - Street 1:720 HARRISON AVE # DOB503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:840 HARRISON AVE
Practice Address - Street 2:MENINO 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-414-4511
Practice Address - Fax:617-414-3171
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090080AMedicaid
MA2366701Medicare PIN