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Organization
MEDICAL PRACTICES OF ANTIETAM LLC
Active
Organization
MEDICAL PRACTICES OF ANTIETAM LLC
Active
Other names
Meritus Urology
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA REPAC (CFO)
(301) 790-9351
Entity
Organization
Contact information
Practice address
11110 MEDICAL CAMPUS RD STE 228, HAGERSTOWN, MD 21742-6727
(301) 733-0022
Mailing address
11110 MEDICAL CAMPUS RD STE 228, HAGERSTOWN, MD 21742-6727
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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