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 147, HAGERSTOWN, MD 21742-6755
(301) 791-5555
Mailing address
1130 PROFESSIONAL CT, HAGERSTOWN, MD 21740-5852
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
Other
Enumeration date
11/05/2024
Last updated
03/10/2026
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