Provider Demographics
NPI:1124100169
Name:HIBSHMAN, KRISTINA KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:KATHLEEN
Last Name:HIBSHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:KATHLEEN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1313
Mailing Address - Country:US
Mailing Address - Phone:703-370-0400
Mailing Address - Fax:
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-370-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242392207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty