Healthcare Provider Details

I. General information

NPI: 1750510525
Provider Name (Legal Business Name): KRISTIN ANNE STUBBEN GORELIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN ANNE STUBBEN M.D.

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 OLD MEADOW RD STE 210
MC LEAN VA
22102-4330
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW # 6A
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-4264
  • Fax: 703-717-4265
Mailing address:
  • Phone: 202-741-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD040655
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA109654
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101274150
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: