Provider Demographics
NPI:1396740510
Name:RIELY, JACQUELINE HERRFELDT (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:HERRFELDT
Last Name:RIELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:STE 340
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6807
Mailing Address - Country:US
Mailing Address - Phone:812-945-5233
Mailing Address - Fax:812-945-2804
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:998-497-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054172A174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000205353OtherBC/BS FACETS
IN200310180AMedicaid
IN160055355OtherMEDICARE RAILROAD
IN200310180AMedicaid
IN000000205353OtherBC/BS FACETS