Provider Demographics
NPI:1487683454
Name:RAYES-PRINCE, EMILY J (MD)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:J
Last Name:RAYES-PRINCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JANE
Other - Last Name:RAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:108 GROVE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2651
Mailing Address - Country:US
Mailing Address - Phone:833-963-2102
Mailing Address - Fax:
Practice Address - Street 1:2208 W ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2762
Practice Address - Country:US
Practice Address - Phone:704-289-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33653208100000X, 2081P2900X
KYKY33653208100000X
NC2009-018022084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000357941OtherBLUE CROSS
KY64336530Medicaid
KYBR4946262OtherDEA
KYBR4946262OtherDEA
G39047Medicare UPIN
KYG39047Medicare UPIN
KY0949701Medicare PIN