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 200, HAGERSTOWN, MD 21742-6797
(301) 714-4400
Mailing address
11110 MEDICAL CAMPUS RD STE 200, HAGERSTOWN, MD 21742-6797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/05/2024
Last updated
11/05/2024
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