ANTIETAM FAMILY HEALTH LLC NPI 1548972318

NPI Information

NPI: 1548972318
Provider Name: ANTIETAM FAMILY HEALTH, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 21D2283320

Address:
1101 OPAL CT STE 217
HAGERSTOWN, MD
ZIP 21740
Phone: (240) 203-8864
Get Directions

ANTIETAM FAMILY HEALTH, LLC is a family nurse practitioner in Hagerstown, MD. ANTIETAM FAMILY HEALTH, LLC NPI is 1548972318. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1101 OPAL CT STE 217
HAGERSTOWN, MD
ZIP 21740-941
Phone: (240) 203-8864
Fax: (240) 866-8173

The provider's authorized official is Mark Anthony Roncone .
The authorized official title is Owner and has the following contact phone number (240) 203-8864.

The CLIA number assigned to this NPI record is 21D2283320 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/23/2022 and was last updated on 9/8/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YP2500X	Counselor	Professional	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	No
3	363LF0000X	Nurse Practitioner	Family	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	287005300	MEDICAID	MARYLAND
2	319064100	MEDICAID	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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