Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Licking Memorial Professional Corp

Organization Pediatrics Physician · NPI 1083634414

Licking Memorial Professional Corp is a Pediatrics Physician in Newark, Ohio. Registered with an NPI since 2006.

In the registry since
2006
What do these letters mean?
Corp — Corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1865 Tamarack Rd
Newark, OH 43055-2305
Phone: (740) 348-4940
Fax: (740) 348-4948
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X

Record details

NPI number1083634414
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Montagnese — Executive V.P. · (740) 348-4000
Other names Licking Memorial Pediatrics
NPI enumeratedJuly 20, 2006
Last updated in NPPESAugust 22, 2020
Mailing address1865 Tamarack Rd, Newark, OH 43055-2305

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