# ANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC

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

## Provider details

- **NPI number:** 1780627810
- **Authorized official:** LEON D WEAVER M.D. (PARTNER)
- **Authorized official phone:** (301) 393-2600

## Contact information

- **Practice address:** 1161 OMEGA DR, HAGERSTOWN, MD 21740-5574
- **Practice address phone:** (301) 393-2600
- **Practice address fax:** (210) 393-2614
- **Mailing address:** 1161 OMEGA DR, HAGERSTOWN, MD 21740-5574
- **Mailing address phone:** (301) 393-2600
- **Mailing address fax:** (210) 393-2614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | MD | Yes |

## Other

- **Enumeration date:** 06/14/2006
- **Last updated:** 07/21/2022