LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1457625758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457625758 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Other Organization Name | LICKING MEMORIAL DERMATOLOGY |
| Practice Address |
1272 West Main Street Bldg 2 Ste. 2 Newark OH 43055 |
| Practice Telephone | 7403481760 |
| Practice Fax Number | 7403481761 |
| Mailing Telephone | 7403481760 |
| Mailing Fax Number | 7403481761 |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2012-03-05 |
| Authorized Official Name | CYNTHIA L. WEBSTER (VP OF FINANCIAL SERVICES) |
| Authorized Official Telephone | 7403484027 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Dermatology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053758631 | Licking Memorial Professional Corporation | Obstetrics & Gynecology | 270 Goosepond Road, Ste 102, Newark, OH 43055 | 2013-05-23 |
| 1740623628 | Licking Memorial Professional Corporation | Internal Medicine | 1272 West Main Street Bldg 2, Ste 4, Newark, OH 43055 | 2013-04-10 |
| 1093955932 | Licking Memorial Professional Corporation | Surgery | 1 Healthy Pl Ste 202, Pataskala, OH 43062-7067 | 2009-03-05 |
| 1083646442 | Licking Memorial Professional Corporation | Otolaryngology | 88 Mcmillen Dr, Newark, OH 43055-5814 | 2006-07-07 |
| 1326436510 | Licking Memorial Professional Corporation | Durable Medical Equipment & Medical Supplies | 1717 W Main St, Suite 201, Newark, OH 43055-1347 | 2014-12-23 |
| 1700291416 | Licking Memorial Professional Corporation | Dermatology | 1 Healthy Pl, Suite 205, Pataskala, OH 43062-7067 | 2014-06-23 |
| 1962684084 | Licking Memorial Professional Corporation | Family Medicine | 75 Mcmillen Dr, Newark, OH 43055-1808 | 2007-11-30 |
| 1952581274 | Licking Memorial Professional Corporation | Family Medicine | 151 Price Rd, Newark, OH 43055-3317 | 2007-11-05 |
| 1578755435 | Licking Memorial Professional Corporation | Psychiatry & Neurology | 1272 West Main Street, Bldg 2, Newark, OH 43055-2004 | 2007-08-15 |
| 1740472604 | Licking Memorial Professional Corporation | Dermatology | 270 Goosepond Rd, Newark, OH 43055-3104 | 2007-08-15 |
| Street Address |
1272 WEST MAIN STREET BLDG 2 STE. 2 |
| City | NEWARK |
| State | OH |
| Zip Code | 43055 |
| 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 | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124464201 | Gina M Caputo | Dermatology | 537 Stanton Christiana Rd Ste 207, Newark, DE 19713 | 2013-05-16 |
| 1659638443 | Thomas J Hagele | Dermatology | 1717 W Main St Ste 204, Newark, OH 43055-1362 | 2012-04-18 |
| 1285896829 | Matthew Russell Hanson | Dermatology | 537 Stanton Christiana Road, Siute 107, Apex Medical Center, Newark, DE 19713-0000 | 2008-06-25 |
| 1669651816 | Larry J Little | Dermatology | 71 S Terrace Ave, Newark, OH 43055-1355 | 2007-10-24 |
| 1871646919 | Burke Dermatology, Pa | Dermatology | 774 Christiana Rd Ste 107, Newark, DE 19713-4248 | 2007-01-20 |
| 1861404709 | Kathleen M. Rogers | Dermatology | 1272 W Main St Ste 203, Newark, OH 43055-2055 | 2006-08-12 |
| 1881698389 | Thomas J. Burke | Dermatology | H48 Omega Drive, Newark, DE 19713 | 2005-06-13 |
| 1023012515 | Helen A. Mashek | Dermatology | 537 Stanton Christiana Rd, Suite # 207, Newark, DE 19713-2146 | 2005-06-13 |
| 1801185681 | Dermatology and Skin Surgery Center-newark LLC | Dermatology | 71 S Terrace Ave, Newark, OH 43055-1355 | 2011-04-01 |
| 1043450356 | Christiana Care Health Services Inc | Dermatology | 200 Hygeia Dr, Health Care Center At Christiana, Newark, DE 19713-2049 | 2009-02-26 |
| Find all providers in NEWARK | ||||
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| 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.