Organization
LICKING MEMORIAL PROFESSIONAL CORPORATION
Active
Other names
Licking Memorial Otolaryngology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT A. MONTAGENSE (EXECUTIVE VICE PRESIDENT)
(740) 348-4000
Entity
Organization
Contact information
Practice address
88 MCMILLEN DR, NEWARK, OH 43055-5814
(740) 348-4270
(740) 348-4272
Mailing address
88 MCMILLEN DR, NEWARK, OH 43055-5814
(740) 348-4270
(740) 348-4272
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
07/07/2006
Last updated
08/22/2020
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