ANTIETAM PEDIATRIC AND ADOLESCENT CARE LLC NPI 1780627810

NPI Information

ANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC is an adolescent medicine pediatrics in Hagerstown, MD. The provider is 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. ANTIETAM PEDIATRIC AND ADOLESCENT CARE, LLC NPI is 1780627810. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1161 OMEGA DR
HAGERSTOWN, MD
ZIP 21740-574
Phone: (301) 393-2600
Fax: (210) 393-2614

The provider's authorized official is Leon D Weaver .
The authorized official title is Partner and has the following contact phone number (301) 393-2600.

The CLIA number assigned to this NPI record is 21D0955037 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/14/2006 and was last updated on 1/30/2013.

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:

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