MEDICAL PRACTICES OF ANTIETAM LLC
NPI 1033990866
Clinic/Center - Ambulatory Surgical in Hagerstown, MD

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.

Active since October 09, 2023CLIA Certified · 2 labs

11110 MEDICAL CAMPUS RD STE 228, HAGERSTOWN, MD 21742(301) 733-0022 Get Directions Write a Review

NPPES record last updated: October 9, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

On this page

About Medical Practices Of Antietam Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDICAL PRACTICES OF ANTIETAM LLC (NPI 1033990866) is a healthcare organization registered as an ambulatory surgical in Hagerstown, Maryland and active in the NPI registry since October 2023. The organization holds 2 active CLIA laboratory certificates and lists Joshua Repac, Cfo, as its authorized official.

NPPES Registry Identity

NPI1033990866

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameMEDICAL PRACTICES OF ANTIETAM LLC

Location Address11110 MEDICAL CAMPUS RD STE 228Hagerstown, MD 21742-6727

Mailing Address11110 Medical Campus Rd Ste 228Hagerstown, MD 21742-6727

Phone(301) 733-0022

Organization SubpartNo

Authorized OfficialJoshua RepacCfo · (301) 790-9351

Enumeration DateOctober 9, 2023

NPPES CertifiedOctober 9, 2023

✔ NPI 1033990866 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

11110 MEDICAL CAMPUS RD STE 228, Hagerstown, MD 21742

Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D2306106

Medical Practices Of Antietam- Mobile Health · Hagerstown, MD

Active · expires Jun 10, 2028

CLIA Number21D2306106

Laboratory TypeMobile Laboratory

Certificate Effective DateJune 11, 2026

Certificate Expiration DateJune 10, 2028

Laboratory DirectorAtchuthanand Budi

Laboratory Phone(301) 790-8624

Laboratory LocationMedical Practices Of Antietam- Mobile Health11110 Medical Campus Rd, Hagerstown, MD 21742

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 21D2281566

Medical Practices Of Antietam LLC Dba · Hagerstown, MD

Active · expires Jul 17, 2027

CLIA Number21D2281566

Laboratory TypePhysician Office

Certificate Effective DateJuly 18, 2025

Certificate Expiration DateJuly 17, 2027

Laboratory DirectorDr. Michael J. O'donoghue

Laboratory Phone(301) 790-8073

Laboratory LocationMedical Practices Of Antietam LLC Dba11110 Medical Campusrd Suite 229, Hagerstown, MD 21742

CLIA data matches this NPI record on: Name

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

UROLOGICAL CENTER P A

Urology