Organization
MEDICAL PRACTICES OF ANTIETAM LLC
Active
Other names
Meritus Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA REPAC (CFO)
(301) 790-9351
Entity
Organization
Contact information
Practice address
17301 VALLEY MALL RD STE 125, HAGERSTOWN, MD 21740-6966
(301) 790-9237
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
03/04/2024
Last updated
03/05/2024
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