Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Medical Practices of Antietam LLC

Organization Neurological Surgery Physician · NPI 1124826862

Medical Practices of Antietam LLC is a Neurological Surgery Physician in Hagerstown, Maryland. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

11110 Medical Campus Rd Ste 143
Hagerstown, MD 21742-6755
Phone: (301) 790-8750
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neurological Surgery Physician (primary) Taxonomy 207T00000X
Nuclear Medicine Physician Taxonomy 207U00000X
General Practice Physician Taxonomy 208D00000X

Record details

NPI number1124826862
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Joshua Repac — Cfo · (301) 790-9351
NPI enumeratedMarch 7, 2025
Last updated in NPPESMarch 10, 2026
Certification dateMarch 10, 2026
Mailing address11116 Medical Campus Rd, Hagerstown, MD 21742-6710

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