Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Medical Practices of Antietam LLC

Organization Family Medicine Physician · NPI 1619790953

Medical Practices of Antietam LLC provides Family Medicine Physician services in Hagerstown, Maryland. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

11110 Medical Campus Rd Ste 200
Hagerstown, MD 21742-6797
Phone: (301) 714-4400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1619790953
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Joshua Repac — Cfo · (301) 790-9351
NPI enumeratedNovember 5, 2024
Last updated in NPPESNovember 5, 2024
Certification dateNovember 5, 2024
Mailing address11110 Medical Campus Rd Ste 200, Hagerstown, MD 21742-6797

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