Licking Memorial Professional Corporation

NPI #1295775435 in Newark, Ohio

Provider Information

NPI Number: 1295775435
Entity Type: Organization
Organization Name: Licking Memorial Professional Corporation
Primary Specialty: Dermatology
Enumeration Date: Jun 7, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 36 MCMILLEN DR
City: Newark
State: Ohio
ZIP Code: 43055-3666
Phone: (740) 348-1755

Authorized Official

Name: ROBERT A. MONTAGNESE
Title: EXECUTIVE ICE PRESIDENT
Phone: (740) 348-4000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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Organizations

Provider Name	Specialty	City
Licking Memorial Professional Corporation	Dermatology	Newark	AI Deep Dive
Licking Memorial Professional Corporation	Dermatology	Newark	AI Deep Dive

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