Organization
LICKING MEMORIAL PROFESSIONAL CORP
Active
Other names
Licking Memorial Inpatients Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A. MONTAGNESE (EXECUTIVE VICE PRESIDENT)
(740) 348-4000
Entity
Organization
Contact information
Practice address
1320 W MAIN ST, NEWARK, OH 43055-1822
(740) 348-3335
(740) 348-4012
Mailing address
1320 W MAIN ST, NEWARK, OH 43055-1822
(740) 348-3335
(740) 348-4012
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
11/17/2006
Last updated
08/22/2020
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