Organization
LICKING MEMORIAL PROFESSIONAL CORP.
Active
Organization
LICKING MEMORIAL PROFESSIONAL CORP.
Active
Other names
Licking Memorial Geriatric Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A MONTAGNESE (EXECUTIVE V.P.)
(740) 348-4000
Entity
Organization
Contact information
Practice address
120 MCMILLEN DR, NEWARK, OH 43055-1809
(740) 348-7935
(740) 348-7936
Mailing address
120 MCMILLEN DR, NEWARK, OH 43055-1809
(740) 348-7935
(740) 348-7936
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
07/20/2006
Last updated
08/22/2020
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