Basic Information
| Provider Information | |||||||||
| NPI: | 1336125525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERLIHY-RAYLA | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAYLA | ||||||||
| OtherFirstName: | DIANE | ||||||||
| OtherMiddleName: | L. HERLIHY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | CNM | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683110 | ||||||||
| FaxNumber: | 5083683113 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683110 | ||||||||
| FaxNumber: | 5083683113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 05/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 128722 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 61225 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | CN0159 | 01 | BLUE SHIELD INDEMNITY | OTHER | 0380920 | 05 | MA | MEDICAID | 2731108 | 01 | CIGNA HEALTH PLAN | OTHER | 420000550 | 01 | RAILROAD MEDICARE | OTHER | 43919 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 43919 | 01 | HEALTHY START | OTHER | CN0159 | 01 | BLUE CARE ELECT | OTHER | 7806647 | 01 | AETNA/US HEALTHCARE | OTHER | AA3614 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | CN0159 | 01 | BLUE SHIELD HMO BLUE | OTHER | RN0016 | 01 | MEDICARE B | OTHER | 0380920 | 01 | MEDICAID/WELFARE | OTHER |