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 246, HAGERSTOWN, MD 21742-6756
(301) 665-4585
Mailing address
11110 MEDICAL CAMPUS RD STE 246, HAGERSTOWN, MD 21742-6756
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
01/06/2025
Last updated
01/06/2025
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