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Dr. Maria Pettit Canter

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NPI Number Detailed Information

Provider Information:

Name: Dr. Maria Pettit Canter
Gender: F
Provider License Number If Given: 101239731

NPI Information:

NPI: 1497749907
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 4/17/2020

Provider Business Mailing Address:

Address: 224D CORNWALL ST NW STE 403
Leesburg, VA 20176
Phone Number: 7037376001
Fax Number: 7034436717

Provider Business Practice Location Address:

Address: 1860 TOWN CENTER DR STE 140
Reston, VA 20190
Phone Number: 329352397
Fax Number: 5715264393

Provider Taxonomy:

Primary: 207VF0040X
Secondary (if any): 2088F0040X
State: VA

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