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
1125 DIAMOND DR, HAGERSTOWN, MD 21740-5857
(301) 790-1482
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
207KA0200X
Allergy Physician
—
—
2080P0201X
Pediatric Allergy/Immunology Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
03/07/2025
Last updated
03/07/2025
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