LICKING MEMORIAL PROFESSIONAL CORP (NPI# 1073822938) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073822938 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP |
| Other Organization Name | LICKING MEMORIAL ENDOCRINOLOGY |
| Practice Address |
1272 W Main St Bldg 2 Ste 3 Newark OH 43055-2004 |
| Practice Telephone | 7403487950 |
| Practice Fax Number | 7403487951 |
| Mailing Telephone | 7403487950 |
| Mailing Fax Number | 7403487951 |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2012-07-31 |
| Authorized Official Name | CYNTHIA L WEBSTER (VP OF FINANCIAL SERVICES) |
| Authorized Official Telephone | 7403484518 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Endocrinology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497937510 | Licking Memorial Professional Corp | Family Medicine | 1450 W Main St, Newark, OH 43055-1825 | 2007-11-30 |
| 1831381797 | Licking Memorial Professional Corp | Family Medicine | 270 Goosepond Rd, Newark, OH 43055-3104 | 2007-08-15 |
| 1972702512 | Licking Memorial Professional Corp | Internal Medicine | 1320 West Main Street, Newark, OH 43055-1822 | 2007-07-13 |
| 1659445070 | Licking Memorial Professional Corp | Pediatrics | 1320 W Main St, Newark, OH 43055-1822 | 2006-11-17 |
| 1730109166 | Licking Memorial Professional Corp | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2006-07-20 |
| 1083634414 | Licking Memorial Professional Corp | Pediatrics | 1865 Tamarack Rd, Newark, OH 43055-2305 | 2006-07-20 |
| 1073531729 | Licking Memorial Professional Corp | Family Medicine | 399 E Main St, Newark, OH 43055-6516 | 2006-07-18 |
| 1851325526 | Licking Memorial Professional Corp | Family Medicine | 1 Healthy Pl, Suite 101, Pataskala, OH 43062-7067 | 2006-07-10 |
| 1255365102 | Licking Memorial Professional Corp | Family Medicine | 151 Woodgate Dr, Johnstown, OH 43031-1198 | 2006-07-10 |
| Street Address |
1272 W MAIN ST BLDG 2 STE 3 |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-2004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043218068 | Carl Waggoner | Family Medicine | 1272 W Main St, Bldg. 5, Newark, OH 43055-2034 | 2005-07-13 |
| 1134430887 | Read's Pharmacy LLC | Pharmacy | 1272 W Main St, Newark, OH 43055-2004 | 2010-06-28 |
| 1396905584 | Christopher Matthew Forbush | Family Medicine | 1272 W Main St, Suite 503, Newark, OH 43055 | 2008-06-11 |
| 1932389335 | Newark Orthopaedics,inc. | Orthopaedic Surgery | 1272 W Main St, Building 2, Newark, OH 43055-2004 | 2007-11-14 |
| 1831381706 | Licking Memorial Professional Corporation | Surgery | 1272 W Main St, Bldg. 2, Newark, OH 43055-2004 | 2007-08-15 |
| 1871654681 | Paul Norman Montalto | Family Medicine | 1272 W Main St, Suite 2, Newark, OH 43055-2004 | 2006-12-13 |
| 1063580199 | Catherine Chiodo | Podiatrist | 1272 W Main St, Building #4, Newark, OH 43055-2004 | 2006-11-30 |
| 1063518926 | Michael Bradshaw Vitt | Dentist | 1272 W Main St, Bldg 3, Newark, OH 43055-2004 | 2006-09-16 |
| 1336169770 | Licking Memorial Professional Corporation | Family Medicine | 1272 W Main St, Bldg. 1, Newark, OH 43055-2004 | 2006-07-20 |
| 1366461386 | Licking Memorial Professional Corp. | Surgery | 1272 W Main St, Bldg. 3, Newark, OH 43055-2004 | 2006-07-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770125585 | Jessica Danielle Dunkle | Case Manager/Care Coordinator | 15 N 3rd Street Suite 300, Newark, OH 43055 | 2019-10-14 |
| 1558910331 | Diana Cleland | Home Health Aide | 25 Western Rd, Apartment A, Newark, OH 43055 | 2019-09-05 |
| 1912424789 | Sandra Lou Fraley | Community/Behavioral Health | 15 North 3rd Street, Suite 300, Newark, OH 43055 | 2017-08-23 |
| 1215450911 | Caitlyn Thella Smith Elkins | Social Worker | 15 N. 3rd St., Newark, OH 43055 | 2017-07-25 |
| 1992227888 | Sierra Elizabeth Donley | Student in an Organized Health Care Education/Training Program | 140 W Church St, Newark, OH 43055 | 2017-07-12 |
| 1386170587 | Patricia Louise Fischer | Pharmacist | 1155 North 21rst Street, Newark, OH 43055 | 2017-05-08 |
| 1689120958 | Bebout Services, LLC | Home Health | 1325 Dayton Road Ne, Newark, OH 43055 | 2016-08-28 |
| 1750834594 | Laura Smith | Registered Nurse | 1445 West Main Street, Suite B, Newark, OH 43055 | 2016-07-28 |
| 1164807277 | Frank Kobe | Psychologist | 116 N. 21st Street, Newark, OH 43055 | 2015-07-30 |
| 1770975898 | Gentle Foot Care, Inc | Podiatrist | 1271 W Main Street, Bldg 1, Newark, OH 43055 | 2015-02-26 |
| Find all providers in zip 43055 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144646738 | Raafia Memon | Internal Medicine | 4735 Ogletown Stanton Rd Ste 3201, Newark, DE 19713-2094 | 2014-03-06 |
| 1073591970 | Ripudaman S Hundal | Internal Medicine | 1082 Old Churchmans Rd, Suite 100, Newark, DE 19713-2143 | 2006-01-03 |
| 1295009660 | First State Endocrinology, Pa | Internal Medicine | 1082 Old Churchmans Rd, Suite 100, Newark, DE 19713-2143 | 2012-03-02 |
| 1396904207 | Eyob M Makonnen | Internal Medicine | 4735 Ogletown Stanton Rd, Map II Suite 3201, Newark, DE 19713-2072 | 2008-06-05 |
| 1649485053 | Kalleen S. Barham | Internal Medicine | 4735 Ogletown Stanton Road, Map 2, Suite 3201, Newark, DE 19713-2094 | 2007-05-11 |
| 1386784551 | Marvin A. Kirschner | Internal Medicine | 90 Bergen St, Suite 4500, Newark, NJ 07103-2425 | 2007-02-07 |
| 1275672511 | Herneet Sahani Md Pa | Internal Medicine | 539 Bloomfield Ave, Newark, NJ 07107 | 2007-02-05 |
| 1790831667 | Endocrine Associates Pa | Internal Medicine | 4745 Ogletown Stanton Road, Suite 208, Newark, DE 19713-2067 | 2007-01-25 |
| 1235216557 | Maya P Raghuwanshi | Internal Medicine | 90 Bergen St, Doc 4500, Newark, NJ 07103-2425 | 2006-11-01 |
| 1407933948 | Monica Girotra | Internal Medicine | 30 Bergen St, Admc 12 1205, Newark, NJ 07107-3000 | 2006-11-01 |
| Find all providers in NEWARK | ||||
Please comment or provide details below to improve the information on LICKING MEMORIAL PROFESSIONAL CORP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.