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

Licking Memorial Professional Corporation

Organization Dermatology Physician · NPI 1295775435

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

In the registry since
2006

Practice location Address checks out

36 McMillen Dr
Newark, OH 43055-3666
Phone: (740) 348-1755
Fax: (740) 348-1756
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1295775435
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Montagnese — Executive Ice President · (740) 348-4000
Other names Licking Memorial Dermatology
NPI enumeratedJune 7, 2006
Last updated in NPPESAugust 22, 2020
Mailing address36 McMillen Dr, Newark, OH 43055-3666

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