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Contact Information

MEDICAL PRACTICES OF ANTIETAM LLC
1125 DIAMOND DR
HAGERSTOWN, MD21740-5857
 Phone: 301-790-1482
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Allergy & Immunology

207K00000X 03 Physician/Allergy/ Immunology
 

Allergy

207KA0200X 03 Physician/Allergy/ Immunology
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Pediatric Allergy/Immunology

2080P0201X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for MEDICAL PRACTICES OF ANTIETAM LLC

NPI Number 1396543930
LBN Legal business name MEDICAL PRACTICES OF ANTIETAM LLC
Authorized official JOSHUA REPAC - (CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 03/07/2025
Last updated 03/07/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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