Licking Memorial Professional Corporation

NPI #1043244965 in Granville, Ohio

Provider Information

NPI Number
1043244965
Entity Type
Organization
Organization Name
Licking Memorial Professional Corporation
Primary Specialty
Family Medicine
Enumeration Date
Jul 10, 2006
Last Updated
Aug 22, 2020

Practice Location

Address
1264 WEAVER DR
State
Ohio
ZIP Code
43023-1257
Phone
(740) 348-1940

Authorized Official

Name
ROBERT A. MONTAGNESE
Title
EXECUTIVE V.P.
Phone
(740) 348-4000

Specialties & Taxonomy Codes

Specialty
Family Medicine

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