Organization
ANTIETAM FAMILY HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ANTHONY RONCONE (OWNER/PROVIDER)
(240) 203-8864
Entity
Organization
Contact information
Practice address
1101 OPAL CT STE 217, HAGERSTOWN, MD 21740-5941
(240) 203-8864
Mailing address
1101 OPAL CT STE 217, HAGERSTOWN, MD 21740-5941
(240) 203-8864
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
09/12/2023
Last updated
09/12/2023
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