OrganizationActive
Medical Practices of Antietam LLC
NPI 1164220703 · Pain Medicine Physician · Hagerstown, MD
Provider details
- NPI number
- 1164220703
- Entity type
- Organization
- Primary specialty
- Pain Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Joshua Repac, Cfo(301) 790-9351
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- General Practice Physician208D00000X
Allopathic & Osteopathic Physicians
Practice location
11110 Medical Campus Rd Ste 225
Hagerstown, MD 21742-6727
Phone: (301) 665-4720
Approximate (ZIP-level) locationGet directions
Mailing address
11116 Medical Campus Rd
Hagerstown, MD 21742-6710
Registry dates
- Enumerated
- 2025-03-07
- Last updated
- 2025-03-07
- Certified
- 2025-03-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.