| Antietam Family Health, Llc | |
|
1101 Opal Ct Ste 217 Hagerstown MD 21740-5941 | |
| (240) 203-8864 | |
| (240) 866-8173 |
| Full Name | Antietam Family Health, Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1101 Opal Ct Ste 217, Hagerstown, Maryland |
| Authorized Official Name and Position | Mark Anthony Roncone (OWNER) |
| Authorized Official Contact | 2402038864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Antietam Family Health, Llc 1101 Opal Ct Ste 217 Hagerstown MD 21740-5941 Ph: (240) 203-8864 | Antietam Family Health, Llc 1101 Opal Ct Ste 217 Hagerstown MD 21740-5941 Ph: (240) 203-8864 |
| NPI Number | 1548972318 |
|---|---|
| Provider Enumeration Date | 12/23/2022 |
| Last Update Date | 09/08/2023 |
| Certification Date | 09/08/2023 |
| Medicare PECOS PAC ID | 6406228246 |
|---|---|
| Medicare Enrollment ID | O20230204000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548972318 | NPI | - | NPPES |
| 287005300 | Medicaid | MD | |
| 319064100 | Medicaid | MD |
| Provider Name | Mark Anthony Roncone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669982872 PECOS PAC ID: 4789942301 Enrollment ID: I20180103000027 |
| Provider Name | Jessica Lloyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770136566 PECOS PAC ID: 5496185951 Enrollment ID: I20201110000034 |
| Provider Name | Danielle Roncone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154521896 PECOS PAC ID: 9436510096 Enrollment ID: I20240124000713 |
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