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NPI Code Detail

MEDICARE: ANTIETAM FAMILY HEALTH, LLC

MEDICARE: ANTIETAM FAMILY HEALTH, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner
2363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1316724842
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANTIETAM FAMILY HEALTH, LLC
Provider Business Mailing Address
First Line : 1101 OPAL CT STE 217
Second Line :
City : HAGERSTOWN
State : MD
Zip : 21740-5941
Country : US
Telephone Number : 240-203-8864
Fax Number :
Provider Business Practice Location Address
First Line : 427 E PATRICK ST
Second Line :
City : FREDERICK
State : MD
Zip : 21701-5777
Country : US
Telephone Number : 240-203-8864
Fax Number :
Authorized Official
Title or Position : OWNER/PROVIDER
Name : MARK ANTHONY RONCONE
Credential :
Telephone Number : 240-203-8864
Provider Enumeration Date : 09/08/2023
Last Update Date : 09/08/2023

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Directions to “ANTIETAM FAMILY HEALTH, LLC ” Practice Location

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