Licking Memorial Professional Corporation

NPI #1740472604 in Newark, Ohio

Provider Information

NPI Number: 1740472604
Entity Type: Organization
Organization Name: Licking Memorial Professional Corporation
Primary Specialty: Dermatology
Enumeration Date: Aug 15, 2007
Last Updated: Aug 15, 2007

Practice Location

Address: 270 GOOSEPOND RD
City: Newark
State: Ohio
ZIP Code: 43055-3104
Phone: (740) 348-7945

Authorized Official

Name: RENEE SPRING-IVES
Title: CREDENTIALING COORDNATOR
Phone: (740) 348-4027

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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