Healthcare Provider Details

I. General information

NPI: 1497749907
Provider Name (Legal Business Name): MARIA PETTIT CANTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA P CANTER MD

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 TOWN CENTER DRIVE, SUITE 225
RESTON VA
20190-5905
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW, SUITE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-293-5239
  • Fax: 571-526-4393
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number0101239731
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101239731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: