LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1578755435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578755435 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Other Organization Name | LICKING MEMORIAL NEUROLOGY |
| Practice Address |
1272 West Main Street Bldg 2 Newark OH 43055-2004 |
| Practice Telephone | 7403487985 |
| Practice Fax Number | 7403487986 |
| Mailing Telephone | 7403487985 |
| Mailing Fax Number | 7403487986 |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2011-05-12 |
| 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 | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Neurology | 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 |
| 1740472604 | Licking Memorial Professional Corporation | Dermatology | 270 Goosepond Rd, Newark, OH 43055-3104 | 2007-08-15 |
| Street Address |
1272 WEST MAIN STREET BLDG 2 |
| 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 |
| 1508086554 | Licking Memorial Professional Corporation | Urology | 1272 West Main Street, Bldg 4, Newark, OH 43055-2004 | 2007-05-01 |
| 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 | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164994166 | Acclaim Neurodiagnostics Group | Psychiatry & Neurology | 537 Stanton Christiana Rd Ste 106, Newark, DE 19713-2145 | 2019-01-02 |
| 1639300676 | Delaware Neuroscience Specialists | Psychiatry & Neurology | 774 Christiana Rd Ste 201b, Newark, DE 19713-4221 | 2009-08-06 |
| 1841461019 | Deren Huang | Psychiatry & Neurology | 150 Mcmillon Drive, Newark, OH 43055 | 2008-03-17 |
| 1477754893 | Maria R Alvarez Prieto | Psychiatry & Neurology | 41 Wilson Ave, Suite 2d, Newark, NJ 07105 | 2007-05-31 |
| 1245257013 | Eugene A Tolomeo | Psychiatry & Neurology | 1312 Driving Park Ave, Newark, NY 14513-1059 | 2006-07-16 |
| 1932131265 | John Robert Pollard | Psychiatry & Neurology | 774 Christiana Road, Suite 201, Newark, DE 19713-4221 | 2006-07-07 |
| 1902858475 | Joseph Handler | Psychiatry & Neurology | 774 Christiana Rd Ste 201, Newark, DE 19713-4221 | 2006-05-16 |
| 1912907197 | Michael M Moussouttas | Psychiatry & Neurology | 4755 Ogletown Stanton Rd Ste 2e99, Newark, DE 19718-2559 | 2005-07-28 |
| 1518317973 | Garland Tang | Psychiatry & Neurology | 150 Mcmillen Dr, Newark, OH 43055-1811 | 2016-06-16 |
| 1356756142 | Sandeep Devarapalli | Psychiatry & Neurology | 200 Hygeia Dr, Newark, DE 19713-2049 | 2014-07-01 |
| 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.