Organization
LICKING MEMORIAL PROFESSIONAL CORPORATION
Active
Other names
Licking Memorial Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A. MONTAGNESE (EXECUTIVE VICE PRESIDENT)
(740) 348-4000
Entity
Organization
Contact information
Practice address
1272 W MAIN ST, BLDG. 1, NEWARK, OH 43055-2004
(740) 348-1702
(740) 348-1703
Mailing address
1272 W MAIN ST, BLDG. 1, NEWARK, OH 43055-2004
(740) 348-1702
(740) 348-1703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2140169
—
OH
Enumeration date
07/20/2006
Last updated
08/22/2020
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