NPIMap

Organization Active NPI

Medical Practices of Antietam LLC

  • General Practice Physician
  • Hagerstown, MD
National Provider Identifier
1821958083
Registry record updated Nov 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MEDICAL PRACTICES OF ANTIETAM LLC
Practice address
11110 Medical Campus Rd Ste 147
Hagerstown, MD 21742-6755
Phone
(301) 665-4920
NPI assigned
Nov 12, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

11110 Medical Campus Rd Ste 147
Hagerstown, MD 21742-6755

Mailing address

11110 Medical Campus Rd Ste 147
Hagerstown, MD 21742-6755

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 19

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

View all 19

Locations

11110 Medical Campus Rd
Ste 147
Hagerstown, MD 21742
Phone (240) 313-9600

NPI Registry JSON

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

{
    "created_epoch": "1762905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762905600000",
    "number": "1821958083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 147",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 147",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426755",
            "telephone_number": "301-665-4920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PRACTICES OF ANTIETAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-12",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "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": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Nov 12, 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.