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 243, HAGERSTOWN, MD 21742-6756
(301) 665-4780
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
—
—
2086X0206X
Surgical Oncology Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
03/07/2025
Last updated
03/07/2025
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