| Medical Practices Of Antietam Llc | |
|
14303 Lake Royer Dr Cascade MD 21719-1602 | |
| (240) 582-0694 | |
| Not Available |
| Full Name | Medical Practices Of Antietam Llc |
|---|---|
| Speciality | General Practice |
| Location | 14303 Lake Royer Dr, Cascade, Maryland |
| Authorized Official Name and Position | Joshua Repac (CFO) |
| Authorized Official Contact | 3017909351 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Practices Of Antietam Llc 11116 Medical Campus Rd Hagerstown MD 21742-6710 Ph: () - | Medical Practices Of Antietam Llc 14303 Lake Royer Dr Cascade MD 21719-1602 Ph: (240) 582-0694 |
| NPI Number | 1750189494 |
|---|---|
| Provider Enumeration Date | 03/07/2025 |
| Last Update Date | 03/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750189494 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |