Organization
MEDICAL PRACTICES OF ANTIETAM LLC
Active
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 143, HAGERSTOWN, MD 21742-6755
(301) 790-8750
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
207U00000X
Nuclear Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
03/07/2025
Last updated
03/10/2026
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