Provider Demographics
NPI:1851657407
Name:PERESECHENSKI, ELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLA
Middle Name:
Last Name:PERESECHENSKI
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 1:6723 WHITTIER AVE STE 206A
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4544
Mailing Address - Country:US
Mailing Address - Phone:703-987-9877
Mailing Address - Fax:571-486-1134
Practice Address - Street 1:6723 WHITTIER AVE STE 206A
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4544
Practice Address - Country:US
Practice Address - Phone:703-987-9877
Practice Address - Fax:571-486-1134
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012671162084P0800X
FLTRN184392084P0800X
DCMD0441962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry