Organization
LICKING MEMORIAL PROFESSIONAL CORP.
Active
Other names
Licking Memorial Pediatrics-Utica
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A. MONTAGNESE (EXECUTIVE V.P.)
(740) 348-4000
Entity
Organization
Contact information
Practice address
240 N. MAIN ST, UTICA, OH 43080
(740) 348-1740
(740) 348-1741
Mailing address
240 N. MAIN ST, UTICA, OH 43080
(740) 348-1740
(740) 348-1741
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2143906
—
OH
Enumeration date
07/14/2006
Last updated
08/22/2020
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