# LICKING MEMORIAL PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Licking Memorial Gastroenterology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770503112
- **Authorized official:** ROBERT A. MONTAGNESE (EXECUTIVE V.P.)
- **Authorized official phone:** (740) 348-4000

## Contact information

- **Practice address:** 1320 W MAIN ST, NEWARK, OH 43055-1822
- **Practice address phone:** (740) 348-4137
- **Practice address fax:** (740) 348-4119
- **Mailing address:** 1320 W MAIN ST, NEWARK, OH 43055-1822
- **Mailing address phone:** (740) 348-4137
- **Mailing address fax:** (740) 348-4119

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/20/2006
- **Last updated:** 08/22/2020