# MEDICAL PRACTICES OF ANTIETAM LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669271086
- **Authorized official:** JOSHUA REPAC (CFO)
- **Authorized official phone:** (301) 790-9351

## Contact information

- **Practice address:** 19800 TRANQUILITY CIR, HAGERSTOWN, MD 21742-4042
- **Practice address phone:** (301) 790-8000
- **Mailing address:** 11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/10/2025
- **Last updated:** 03/10/2025