MEDICAL PRACTICES OF ANTIETAM LLC – NPI #1710700042
Obstetrics & Gynecology

A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions.

Health Care Provider Taxonomy Code for Obstetrics & Gynecology

MEDICAL PRACTICES OF ANTIETAM LLC is a provider located in HAGERSTOWN, MD. NPPES has assigned the NPI number 1710700042 to MEDICAL PRACTICES OF ANTIETAM LLC on November 05, 2024. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 207VG0400X from the Health Care Provider Taxonomy code set, which is classified as Obstetrics & Gynecology, specializing in Gynecology

The NPI profile was last updated on Mar 10, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MEDICAL PRACTICES OF ANTIETAM LLC below.

NPI Profile for
MEDICAL PRACTICES OF ANTIETAM LLC

NPI Number
1710700042
Enumeration Date

(more than a year ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MEDICAL PRACTICES OF ANTIETAM LLC
Primary location
11110 MEDICAL CAMPUS RD STE 147
HAGERSTOWN, MD 21742-6755
Phone: (301) 791-5555 Fax:
Mailing address
1130 PROFESSIONAL CT
HAGERSTOWN, MD 21740-5852
Phone: Fax:
Organization Subpart
No
Authorized Official
JOSHUA REPAC
CFO
Phone: (301) 790-9351
Updated
Certification Date
Mar 10, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207VG0400X
- Obstetrics & Gynecology / Gynecology (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.