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MEDICAL PRACTICES OF ANTIETAM LLC
NPI 1104767771
Psychiatry & Neurology - Neurology in Hagerstown, MD

Active since April 06, 2026CLIA Certified · 2 labs
235 MILL ST STE 1, HAGERSTOWN, MD 21740(301) 739-5959 Get Directions Write a Review

NPPES record last updated: April 6, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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 1104767771) is a healthcare organization registered as a neurology in Hagerstown, Maryland and active in the NPI registry since April 2026. The organization holds 2 active CLIA laboratory certificates and lists Joshua Repac, Cfo, as its authorized official.

NPPES Registry Identity

NPI1104767771
Entity TypeOrganization
Primary Taxonomy2084N0400X
Legal Business NameMEDICAL PRACTICES OF ANTIETAM LLC
Location Address235 MILL ST STE 1Hagerstown, MD 21740-6668
Mailing Address11116 Medical Campus RdHagerstown, MD 21742-6710
Phone(301) 739-5959
Organization SubpartNo
Authorized OfficialJoshua RepacCfo · (301) 790-9351
Enumeration DateApril 6, 2026
NPPES CertifiedApril 6, 2026
✔ NPI 1104767771 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
235 MILL ST STE 1, Hagerstown, MD 21740
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 21D2056427

Medical Practices Of Antietam- Western Heights Mid · Hagerstown, MD
Active · expires Mar 26, 2027
CLIA Number21D2056427
Laboratory TypeSchool/Student Health Service
Certificate Effective DateMarch 27, 2025
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorAtchuthanand Budi
Laboratory Phone(301) 766-8771
Laboratory LocationMedical Practices Of Antietam- Western Heights Mid1300 Marshall Street, Hagerstown, MD 21740
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 21D2056430

Medical Practices Of Antietam/South Hagerstown Hig · Hagerstown, MD
Active · expires Mar 26, 2027
CLIA Number21D2056430
Laboratory TypeSchool/Student Health Service
Certificate Effective DateMarch 27, 2025
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorMr. Atchuthanand Budi
Laboratory Phone(301) 766-8771
Laboratory LocationMedical Practices Of Antietam/South Hagerstown Hig1101 South Potomac Street, Hagerstown, MD 21740
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

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

JADA DENISE SEWELL CRNP-FNP
Nurse Practitioner (Family)
235 MILL ST STE 1
HAGERSTOWN, MD 21740
Washington County (301) 739-5959
DR. SAID SALAH DAHBOUR MD
Psychiatry & Neurology (Neurology)
235 MILL ST STE 1
HAGERSTOWN, MD 21740
Washington County (301) 739-5959

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Medical Practices Of Antietam LLC's NPI number?

The NPI number for Medical Practices Of Antietam LLC is 1104767771. It was assigned to this organization in the NPPES registry on April 6, 2026.

Where is Medical Practices Of Antietam LLC located?

Medical Practices Of Antietam LLC is located at 235 Mill St Ste 1, Hagerstown, MD 21740. The listed phone number is (301) 739-5959.

What is Medical Practices Of Antietam LLC's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Does Medical Practices Of Antietam LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Medical Practices Of Antietam LLC was last updated on April 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.