NPIMap

Organization Active NPI

Medical Practices of Antietam LLC

  • Gastroenterology Physician
  • Hagerstown, MD
National Provider Identifier
1497553135
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
MEDICAL PRACTICES OF ANTIETAM LLC
Practice address
11110 Medical Campus Rd Ste 242
Hagerstown, MD 21742-6728
Phone
(240) 513-7072
NPI assigned
Mar 7, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary
Nuclear Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207U00000X

Addresses

Primary practice location

11110 Medical Campus Rd Ste 242
Hagerstown, MD 21742-6728

Mailing address

11116 Medical Campus Rd
Hagerstown, MD 21742-6710

National Provider Directory

National Provider Directory
Tax ID family
Medical Practices of Antietam LLC62 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1497553135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11116 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 242",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426728",
            "telephone_number": "240-513-7072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PRACTICES OF ANTIETAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-07",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "REPAC",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "301-790-9351"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.