Antietam Pediatric and Adolescent Care, LLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

ANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC

Practice address

1161 Omega Dr
Hagerstown, MD 21740-5574

Phone

(301) 393-2600

Fax

(210) 393-2614

NPI assigned

Jun 14, 2006

Organization subpart

No

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

Authorized official

Name

Leon D Weaver, M.D.

Title

Partner

Phone

(301) 393-2600

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1780627810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1161 OMEGA DR",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405574",
            "telephone_number": "301-393-2600",
            "fax_number": "210-393-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1161 OMEGA DR",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405574",
            "telephone_number": "301-393-2600",
            "fax_number": "210-393-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "LEON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "301-393-2600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Antietam Orthodontics
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• Antietam Surgeons Charles R Chaney MD PA
• Antietam Urosurgical Center LLC ASC
• Lauryn Antolock
• Constance Adams Anton, MD

• Pediatric Adolescent Medicine Physician in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Pediatric Adolescent Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.