Organization
ANTIETAM FAMILY HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ANTHONY RONCONE (OWNER-PROVIDER)
(240) 203-8864
Entity
Organization
Contact information
Practice address
330 FREDERICK ST, HAGERSTOWN, MD 21740-6112
(240) 203-8864
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
Enumeration date
02/04/2025
Last updated
02/24/2026
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