Provider Demographics
NPI:1942399530
Name:FARRICIELLI, ELLA VIKTOROVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLA
Middle Name:VIKTOROVNA
Last Name:FARRICIELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELLA
Other - Middle Name:VIKTOROVNA
Other - Last Name:AKSENOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:505 N HIGHWAY 77
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1128
Mailing Address - Country:US
Mailing Address - Phone:972-923-1686
Mailing Address - Fax:972-937-7731
Practice Address - Street 1:505 N HIGHWAY 77
Practice Address - Street 2:SUITE 200
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1128
Practice Address - Country:US
Practice Address - Phone:972-923-1686
Practice Address - Fax:972-937-7731
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN10075207R00000X
TXN7920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CR652OtherBCBSTX
TX280059101Medicaid
FLRES000Medicare UPIN
TX280059101Medicaid
TXTXB125759Medicare PIN