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

Licking Memorial Professional Corporation

Organization Family Medicine Physician · NPI 1043244965

Licking Memorial Professional Corporation is a Family Medicine Physician in Granville, Ohio. Registered with an NPI since 2006.

In the registry since
2006

Practice location Address checks out

1264 Weaver Dr
Granville, OH 43023-1257
Phone: (740) 348-1940
Fax: (740) 348-1941
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1043244965
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Montagnese — Executive V.P. · (740) 348-4000
Other names Licking Memorial Family Practice-Granville
NPI enumeratedJuly 10, 2006
Last updated in NPPESAugust 22, 2020
Mailing address1264 Weaver Dr, Granville, OH 43023-1257

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