Organization
LICKING MEMORIAL PROFESSIONAL CORP
Active
Other names
Licking Memorial Geriatric Medicine at Flint Ridge
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS N. POULSON (CFO)
(740) 348-4110
Entity
Organization
Contact information
Practice address
1450 W MAIN ST, NEWARK, OH 43055-1825
(740) 348-7935
(740) 348-7936
Mailing address
1450 W MAIN ST, NEWARK, OH 43055-1825
(740) 348-7935
(740) 348-7936
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
11/30/2007
Last updated
11/30/2007
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