Licking Memorial Professional Corporation

NPI #1700291416 in Pataskala, Ohio

Provider Information

NPI Number: 1700291416
Entity Type: Organization
Organization Name: Licking Memorial Professional Corporation
Subpart: Yes (part of a larger organization)
Parent Organization: LICKING MEMORIAL PROFESSIONAL CORPORATION
Primary Specialty: Dermatology
Enumeration Date: Jun 23, 2014
Last Updated: Jun 23, 2014

Practice Location

Address: 1 HEALTHY PL
Address 2: SUITE 205
City: Pataskala
State: Ohio
ZIP Code: 43062-7067
Phone: (740) 348-1930

Authorized Official

Name: CYNTHIA L. WEBSTER
Title: VP FINANCIAL SERVICES
Phone: (740) 348-4518

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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