Provider Demographics
NPI:1922050343
Name:REILLY, RAYMOND JOHN (MBBCH BAO)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOHN
Last Name:REILLY
Suffix:
Gender:M
Credentials:MBBCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BOYLSTON ST
Mailing Address - Street 2:SUITE 301 NEW ENGLAND OB/GYN ASSOCIATES
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2012
Mailing Address - Country:US
Mailing Address - Phone:617-731-3400
Mailing Address - Fax:
Practice Address - Street 1:200 BOYLSTON ST
Practice Address - Street 2:SUITE 301 NEW ENGLAND OB/GYN ASSOCIATES
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2012
Practice Address - Country:US
Practice Address - Phone:617-731-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28257207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology