Licking Memorial Professional Corp

NPI #1659445070 in Newark, Ohio

Provider Information

NPI Number: 1659445070
Entity Type: Organization
Organization Name: Licking Memorial Professional Corp
Primary Specialty: Pediatrics
Enumeration Date: Nov 17, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1320 W MAIN ST
City: Newark
State: Ohio
ZIP Code: 43055-1822
Phone: (740) 348-3335

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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