LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1508086554) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508086554 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Other Organization Name | LICKING MEMORIAL UROLOGY |
| Practice Address |
1272 West Main Street Bldg 4 Newark OH 43055-2004 |
| Practice Telephone | 7403481750 |
| Practice Fax Number | 7403481751 |
| Mailing Telephone | 7403481750 |
| Mailing Fax Number | 7403481751 |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2011-08-03 |
| 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 | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Urology | 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 |
| 1457625758 | Licking Memorial Professional Corporation | Dermatology | 1272 West Main Street Bldg 2 Ste. 2, Newark, OH 43055 | 2012-03-05 |
| 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 |
| Street Address |
1272 WEST MAIN STREET BLDG 4 |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-2004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427044114 | John Marvin Mitchell | Surgery | 1272 West Main Street, Suite 302, Newark, OH 43055 | 2005-09-27 |
| 1104080977 | Marco Mauro De Santis | Internal Medicine | 1272 West Main Street, Suite 204, Newark, OH 43055 | 2008-07-10 |
| 1427225630 | Ahmed F. Kandeel | Surgery | 1272 West Main Street, Suite 302, Newark, OH 43055 | 2008-05-15 |
| 1578755435 | Licking Memorial Professional Corporation | Psychiatry & Neurology | 1272 West Main Street, Bldg 2, Newark, OH 43055-2004 | 2007-08-15 |
| 1104894401 | Shawn L. Reed | Internal Medicine | 1272 West Main Street, Newark, OH 43055 | 2006-03-10 |
| 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 | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861802373 | Jeffrey Spencer | Urology | 1202 Driving Park Ave Ste 5, Newark, NY 14513 | 2014-05-06 |
| 1407029051 | Ronaldo L. Domingo Md Pa | Urology | 620 Christiana Medical Ctr, Newark, DE 19702-1656 | 2008-04-03 |
| 1679633374 | Peter J Muench Md Pa | Urology | H50 Omega Drive, Newark, DE 19713 | 2006-12-11 |
| 1972617314 | Donald J Lewis | Urology | 1902 Tamarack Rd, Newark, OH 43055 | 2006-08-19 |
| 1457312597 | William Alvin Stallworth | Urology | 1272 W Main St Ste 401, Newark, OH 43055-2056 | 2006-03-29 |
| 1427023639 | Peter J Muench | Urology | H 50 Omega Drive, Newark, DE 19713 | 2006-02-21 |
| 1023375011 | Benjamin Jon Nelson | Urology | 1202 Driving Park Ave, Newark, NY 14513 | 2012-04-16 |
| 1255613576 | Branford Medical Group, PC | Urology | 23 Branford Pl, Newark, NJ 07102-2711 | 2011-09-13 |
| 1427361005 | Newark-wayne Urology Pllc | Urology | 1202 Driving Park Ave, Suite 5, Newark, NY 14513-1057 | 2010-07-23 |
| 1164675955 | Rochester General Hospital | Urology | 1202 Driving Park Ave, Newark, NY 14513-1057 | 2008-10-24 |
| 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.