Provider Demographics
NPI:1558516690
Name:ELA, KURT W (PSYD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:W
Last Name:ELA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 15TH ST N
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2683
Mailing Address - Country:US
Mailing Address - Phone:202-687-8609
Mailing Address - Fax:202-687-8577
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:PSYCHIATRY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-687-8609
Practice Address - Fax:202-687-8577
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00719075OtherRAILROAD MEDICARE
DC142300ZATQMedicare PIN