Organization
LICKING MEMORIAL PROFESSIONAL CORP.
Active
Other names
Licking Memorial Occupational Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A. MONTAGENSE (EXECUTIVE V.P.)
(740) 348-4000
Entity
Organization
Contact information
Practice address
1865 TAMARACK RD, NEWARK, OH 43055-2305
(740) 348-4972
(740) 348-4991
Mailing address
1865 TAMARACK RD, NEWARK, OH 43055-2305
(740) 348-4972
(740) 348-4991
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2354134
—
OH
Enumeration date
07/20/2006
Last updated
08/22/2020
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