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

Licking Memorial Professional Corp

Organization Geriatric Medicine (Family Medicine) Physician · NPI 1497937510

Licking Memorial Professional Corp is a Geriatric Medicine (Family Medicine) Physician in Newark, Ohio. Registered with an NPI since 2007.

In the registry since
2007
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

1450 W Main St
Newark, OH 43055-1825
Phone: (740) 348-7935
Fax: (740) 348-7936
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Family Medicine) Physician (primary) Taxonomy 207QG0300X

Record details

NPI number1497937510
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Thomas Poulson — Cfo · (740) 348-4110
Other names Licking Memorial Geriatric Medicine At Flint Ridge
NPI enumeratedNovember 30, 2007
Last updated in NPPESNovember 30, 2007
Mailing address1450 W Main St, Newark, OH 43055-1825

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