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 provides Geriatric Medicine (Family Medicine) Physician services 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 Not confirmed with CMS for 18 years — call before visiting
Phone: (740) 348-7935
Fax: (740) 348-7936
Show map & directions

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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