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 provides Dermatology Physician services 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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