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

Licking Memorial Professional Corporation

Organization Plastic and Reconstructive Surgery Physician · NPI 1831381706

Licking Memorial Professional Corporation is a Plastic and Reconstructive Surgery Physician in Newark, Ohio. Registered with an NPI since 2007.

In the registry since
2007

Practice location Address checks out

1272 W Main St Bldg 2
Newark, OH 43055-2004
Phone: (740) 348-7955
Fax: (740) 348-7956
Show map & directions

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

Specialties & licences

Plastic and Reconstructive Surgery Physician (primary) Taxonomy 2086S0122X

Record details

NPI number1831381706
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Renee Spring-Ives — Credentialing Coordinator · (740) 348-4027
Other names Licking Memorial Reconstructive & Cosmetic Services
NPI enumeratedAugust 15, 2007
Last updated in NPPESAugust 15, 2007
Mailing address1272 W Main St, Bldg. 2, Newark, OH 43055-2004