Licking Memorial Professional Corp

NPI #1083634414 in Newark, Ohio

Provider Information

NPI Number: 1083634414
Entity Type: Organization
Organization Name: Licking Memorial Professional Corp
Primary Specialty: Pediatrics
Enumeration Date: Jul 20, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1865 TAMARACK RD
City: Newark
State: Ohio
ZIP Code: 43055-2305
Phone: (740) 348-4940

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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