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MEDICAL PRACTICES OF ANTIETAM LLC
NPI 1750189494
General Practice in Cascade, MD

Active since March 07, 2025
14303 LAKE ROYER DR, CASCADE, MD 21719(240) 582-0694 Get Directions Write a Review

NPPES record last updated: March 7, 2025. Verified against the NPPES registry weekly; last sync: August 02, 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 1750189494) is a healthcare organization registered as a general practice in Cascade, Maryland and active in the NPI registry since March 2025. The organization lists Joshua Repac, Cfo, as its authorized official.

NPPES Registry Identity

NPI1750189494
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameMEDICAL PRACTICES OF ANTIETAM LLC
Location Address14303 LAKE ROYER DRCascade, MD 21719-1602
Mailing Address11116 Medical Campus RdHagerstown, MD 21742-6710
Phone(240) 582-0694
Organization SubpartNo
Authorized OfficialJoshua RepacCfo · (301) 790-9351
Enumeration DateMarch 7, 2025
NPPES CertifiedMarch 7, 2025
✔ NPI 1750189494 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedInternal MedicineTaxonomy 207R00000X
14303 LAKE ROYER DR, Cascade, MD 21719
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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

Other Providers at the Same Location NPPES 3

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

MRS. CHRISTINE ANN DIAMOND CNP
Nurse Practitioner (Family)
14303 LAKE ROYER DR
CASCADE, MD 21719
Washington County (240) 852-0694
BRENDA L VITUCCI CRNP
Nurse Practitioner (Family)
14303 LAKE ROYER DR
CASCADE, MD 21719
Washington County (240) 852-0694
LORRI RICE
Nurse Practitioner (Family)
14303 LAKE ROYER DR
CASCADE, MD 21719
Washington County (240) 852-0694

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 1750189494. It was assigned to this organization in the NPPES registry on March 7, 2025.

Where is Medical Practices Of Antietam LLC located?

Medical Practices Of Antietam LLC is located at 14303 Lake Royer Dr, Cascade, MD 21719. The listed phone number is (240) 582-0694.

What is Medical Practices Of Antietam LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Medical Practices Of Antietam LLC was last updated on March 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.