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Organization

MEDICAL PRACTICES OF ANTIETAM LLC

Active
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 150, HAGERSTOWN, MD 21742-6755
(301) 665-4825
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
208D00000X
General Practice Physician

Other

Enumeration date
03/07/2025
Last updated
03/07/2025
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