OrganizationActive
Medical Practices of Antietam LLC
NPI 1265275341 · Sports Medicine (Emergency Medicine) Physician · Hagerstown, MD
Provider details
- NPI number
- 1265275341
- Entity type
- Organization
- Primary specialty
- Sports Medicine (Emergency Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Joshua Repac, Cfo(301) 790-9351
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
17301 Valley Mall Rd Ste 125
Hagerstown, MD 21740-6966
Phone: (301) 790-9237
Approximate (ZIP-level) locationGet directions
Mailing address
17301 Valley Mall Rd Ste 125
Hagerstown, MD 21740-6966
Registry dates
- Enumerated
- 2024-06-17
- Last updated
- 2024-06-17
- Certified
- 2024-06-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.