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ANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC
NPI 1780627810
Pediatrics - Adolescent Medicine in Hagerstown, MD

Active since June 14, 2006CLIA 21D0955037 · Microscopy
1161 OMEGA DR, HAGERSTOWN, MD 21740(301) 393-2600(210) 393-2614 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Antietam Pediatric And Adolescent Care, Llc NPPES

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

ANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC (NPI 1780627810) is a healthcare organization registered as an adolescent medicine in Hagerstown, Maryland and active in the NPI registry since June 2006. The organization holds a CLIA Microscopy certificate valid through December 16, 2026 and lists Leon D Weaver, Partner, as its authorized official.

NPPES Registry Identity

NPI1780627810
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC
Location Address1161 OMEGA DRHagerstown, MD 21740-5574
Mailing Address1161 Omega DrHagerstown, MD 21740-5574 · (301) 393-2600 · Fax (210) 393-2614
Phone(301) 393-2600
Fax(210) 393-2614
Organization SubpartNo
Authorized OfficialLeon D WeaverPartner · (301) 393-2600
Enumeration DateJune 14, 2006
Last NPPES UpdateJuly 21, 2022
✔ NPI 1780627810 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
1161 OMEGA DR, Hagerstown, MD 21740
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

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 for Provider-Performed Microscopy Procedures (PPMP) 21D0955037

Antietam Pediatric & Adolescent Care · Hagerstown, MD
Active · expires Dec 16, 2026
CLIA Number21D0955037
Laboratory TypePhysician Office
Certificate Effective DateDecember 17, 2024
Certificate Expiration DateDecember 16, 2026
Laboratory DirectorDr. Leon Weaver Jr
Laboratory Phone(301) 393-2600
Laboratory LocationAntietam Pediatric & Adolescent Care1161 Omega Drive, Hagerstown, MD 21740
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 10

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

CRANIAL TECHNOLOGIES, INC.
Prosthetic/Orthotic Supplier
1161 OMEGA DR
HAGERSTOWN, MD 21740
Washington County (301) 683-9808
LEON D WEAVER M.D.
Pediatrics (Adolescent Medicine)
1161 OMEGA DR
HAGERSTOWN, MD 21740
Washington County (301) 393-2600
RUTH A DWYER M.D.
Pediatrics (Adolescent Medicine)
1161 OMEGA DR
HAGERSTOWN, MD 21740
Washington County (301) 393-2600
KRISTINA ALMA ATHEY M.D.
Pediatrics
1161 OMEGA DR, STE 100
HAGERSTOWN, MD 21740
Washington County (301) 393-2600
DR. ALICIA RENEE ISOM D.O.
Pediatrics
1161 OMEGA DR
HAGERSTOWN, MD 21740
Washington County (301) 393-2600
JULIA D OAKLEY M.D.
Pediatrics
1161 OMEGA DR, STE 100
HAGERSTOWN, MD 21740
Washington County (301) 393-2600
KAREN E BARB CRNP
Nurse Practitioner (Pediatrics)
1161 OMEGA DR
HAGERSTOWN, MD 21740
Washington County (301) 393-2600
NORA KATERJI M.D
Pediatrics
1161 OMEGA DR
HAGERSTOWN, MD 21740
Washington County (301) 393-2600

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 Antietam Pediatric And Adolescent Care, LLC's NPI number?

The NPI number for Antietam Pediatric And Adolescent Care, LLC is 1780627810. It was assigned to this organization in the NPPES registry on June 14, 2006.

Where is Antietam Pediatric And Adolescent Care, LLC located?

Antietam Pediatric And Adolescent Care, LLC is located at 1161 Omega Dr, Hagerstown, MD 21740. The listed phone number is (301) 393-2600.

What is Antietam Pediatric And Adolescent Care, LLC's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Antietam Pediatric And Adolescent Care, LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 21D0955037) is associated with this NPI, valid through December 16, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Antietam Pediatric And Adolescent Care, LLC was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.