Provider Demographics
NPI:1578533642
Name:GORNY, KRISTIE NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:NICOLE
Last Name:GORNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTIE
Other - Middle Name:NICOLE
Other - Last Name:MARQUIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11125 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:N BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-230-2280
Mailing Address - Fax:301-230-2245
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 209
Practice Address - City:N BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-230-2280
Practice Address - Fax:301-230-2245
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00672652080A0000X
DCMD0349182080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine