Healthcare Provider Details

I. General information

NPI: 1912603853
Provider Name (Legal Business Name): JESSICA R CANTOR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SANGAMORE RD STE N100
BETHESDA MD
20816-2558
US

IV. Provider business mailing address

1-3 WILLOW WAY
READING PA
19606-3219
US

V. Phone/Fax

Practice location:
  • Phone: 484-334-5844
  • Fax:
Mailing address:
  • Phone: 484-334-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: