Organization
LICKING MEMORIAL PROFESSIONAL CORPORATION
Active
Other names
Licking Memorial Dermatology North Newark
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE SPRING-IVES (CREDENTIALING COORDNATOR)
(740) 348-4027
Entity
Organization
Contact information
Practice address
270 GOOSEPOND RD, NEWARK, OH 43055-3104
(740) 348-7945
(740) 348-7946
Mailing address
270 GOOSEPOND RD, NEWARK, OH 43055-3104
(740) 348-7945
(740) 348-7946
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
08/15/2007
Last updated
08/15/2007
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