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

Licking Memorial Professional Corporation

Organization Geriatric Medicine (Family Medicine) Physician · NPI 1962684084

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

In the registry since
2007

Practice location Address checks out

75 McMillen Dr
Newark, OH 43055-1808
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 number1962684084
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Thomas Poulson — Cfo · (740) 348-4110
Other names Licking Memorial Geratrics At Nhc
NPI enumeratedNovember 30, 2007
Last updated in NPPESNovember 30, 2007
Mailing address75 McMillen Dr, Newark, OH 43055-1808

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