Organization
ANTIETAM FAMILY HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ANTHONY RONCONE FNP (OWNER)
(240) 203-8864
Entity
Organization
Contact information
Practice address
1219 MOUNT AETNA RD STE 201, HAGERSTOWN, MD 21742-6550
(240) 203-8864
(240) 866-8173
Mailing address
1219 MOUNT AETNA RD STE 201, HAGERSTOWN, MD 21742-6550
(240) 203-8864
(240) 866-8173
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287005300
—
MD
05
—
319064100
—
MD
Enumeration date
12/23/2022
Last updated
02/24/2026
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