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
17301 VALLEY MALL RD STE 125, HAGERSTOWN, MD 21740-6966
(301) 790-8000
Mailing address
17301 VALLEY MALL RD STE 125, HAGERSTOWN, MD 21740-6966
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/08/2025
Last updated
07/08/2025
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