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 1336169770

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

In the registry since
2006

Practice location Address checks out

1272 W Main St Bldg 1
Newark, OH 43055-2004
Phone: (740) 348-1702
Fax: (740) 348-1703
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1336169770
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Montagnese — Executive Vice President · (740) 348-4000
Other names Licking Memorial Family Practice
NPI enumeratedJuly 20, 2006
Last updated in NPPESAugust 22, 2020
Mailing address1272 W Main St, Bldg. 1, Newark, OH 43055-2004

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