NPI 1710700042

Medical Practices of Antietam LLC

Organisation Gynecology Physician Hagerstown, MD

Practice location

Address: 11110 Medical Campus Rd STE 147, Hagerstown, MD 21742-6755
Phone: (301) 791-5555
Mailing address: 1130 Professional CT, Hagerstown, MD 21740-5852

Authorised official

Name: Joshua Repac
Title: Cfo
Phone: (301) 790-9351

Registered specialties

Gynecology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207VG0400X

Other Obstetrics & Gynecology providers in Maryland →

Registry record

NPI: 1710700042
Entity type: Organization
NPI issued: 5 Nov 2024
Record last updated: 10 Mar 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.