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Organization
LICKING MEMORIAL PROFESSIONAL CORPORATION
Active
Organization
LICKING MEMORIAL PROFESSIONAL CORPORATION
Active
Other names
Licking Memorial Gastroenterology
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A. MONTAGNESE (EXECUTIVE V.P.)
(740) 348-4000
Entity
Organization
Contact information
Practice address
1320 W MAIN ST, NEWARK, OH 43055-1822
(740) 348-4137
(740) 348-4119
Mailing address
1320 W MAIN ST, NEWARK, OH 43055-1822
(740) 348-4137
(740) 348-4119
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
NULL
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
07/20/2006
Last updated
08/22/2020
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