LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1649290073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1649290073 |
Entity Type | Organization |
Organization Name | LICKING MEMORIAL PROFESSIONAL CORP. |
Other Organization Name | LICKING MEMORIAL GERIATRIC MEDICINE |
Practice Address |
120 Mcmillen Dr Newark OH 43055-1809 |
Practice Telephone | 7403487935 |
Practice Fax Number | 7403487936 |
Mailing Telephone | 7403487935 |
Mailing Fax Number | 7403487936 |
Enumeration Date | 2006-07-20 |
Last Update Date | 2020-08-22 |
Authorized Official Name | ROBERT A MONTAGNESE (EXECUTIVE V.P.) |
Authorized Official Telephone | 7403484000 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Licking Memorial Geriatric Medicine | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235311358 | Licking Memorial Professional Corp. | Family Medicine | 17 Forry St, Newark, OH 43055-4004 | 2007-11-30 |
1497771521 | Licking Memorial Professional Corp. | Pediatrics | 240 N. Main St, Utica, OH 43080 | 2006-07-14 |
1689690661 | Licking Memorial Professional Corp. | Family Medicine | 96 Integrity Drive, H., Hebron, OH 43025 | 2006-07-14 |
1487688545 | Licking Memorial Professional Corp. | Family Medicine | 687 Hopewell Dr, Suite2, Heath, OH 43056-1579 | 2006-07-11 |
1598945818 | Licking Memorial Professional Corp. | Family Medicine | 717 S 30th St, Newark, OH 43056-1244 | 2007-11-05 |
1669547824 | Licking Memorial Professional Corp. | Pediatrics | 399 E Main St, Newark, OH 43055-6516 | 2006-11-22 |
1154496503 | Licking Memorial Professional Corp. | General Practice | 2000 Tamarack Rd, Newark, OH 43055 | 2006-11-21 |
1295809614 | Licking Memorial Professional Corp. | Psychiatry & Neurology | 1 Healthy Pl, Suite 105, Pataskala, OH 43062-7067 | 2006-11-17 |
1326068768 | Licking Memorial Professional Corp. | Internal Medicine | 1320 West Main Street, Newark, OH 43055-1822 | 2006-07-20 |
1235159674 | Licking Memorial Professional Corp. | Obstetrics & Gynecology | 1 Healthy Pl, Suite 103, Pataskala, OH 43062-7067 | 2006-07-20 |
Street Address |
120 MCMILLEN DR |
City | NEWARK |
State | OH |
Zip Code | 43055-1809 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023017860 | Mark Mitchell | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2005-07-14 |
1568857746 | Nishi Patel | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055 | 2015-04-03 |
1588007017 | Nina Pola Hourmouzis | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055 | 2013-04-15 |
1871813691 | Even Fengyuan Wang | Psychiatry & Neurology | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2010-06-03 |
1174782775 | Daria J Hopkins | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2008-06-09 |
1003005034 | Misti D. Staggers | Clinical Nurse Specialist | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2007-10-16 |
1730109166 | Licking Memorial Professional Corp | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2006-07-20 |
1740289941 | Gerald Ehrsam | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2005-07-19 |
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 | 207RG0300X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Geriatric Medicine |
An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
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 |
---|---|---|---|---|
1902009459 | Alexander Kolessa | Internal Medicine | 188 Jefferson St, Suite# 111, Newark, NJ 07105-1622 | 2007-06-11 |
1609909431 | Hockessin Comprehensive Care | Internal Medicine | 71 Hidden Valley Dr, Newark, DE 19711-7463 | 2007-03-13 |
1114451234 | Claudia Lynch | Internal Medicine | 972 Broad St, Newark, NJ 07102-2533 | 2017-04-14 |
1346208923 | Nbimc Department of Geriatrics | Internal Medicine | 201 Lyons Ave, Newark, NJ 07112-2027 | 2006-05-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689298119 | Np Insight | Internal Medicine | 4996 Pigeon Run Rd Sw, Navarre, OH 44662-8123 | 2020-06-01 |
1164082764 | Phoenix Help LLC | Internal Medicine | 7215 Winding Way, Cincinnati, OH 45236-3340 | 2019-06-17 |
1790343846 | Geriatric Care Providers Inc | Internal Medicine | 2605 Greenbrier Ct, Beavercreek, OH 45431-8564 | 2019-06-04 |
1538698568 | David John Donofrio | Internal Medicine | 6427 Stonecrest Dr, Brookpark, OH 44142-3767 | 2017-06-04 |
1346690757 | Detroit 74th Medical Clinic Inc | Internal Medicine | 4805 Lorain Ave, Cleveland, OH 44102-3351 | 2016-06-16 |
1245610179 | Sarah Hyun Hong Min | Internal Medicine | 2355 Norwood Ave Ste 1, Cincinnati, OH 45212-2750 | 2015-06-05 |
1326434127 | Hiba Khan | Internal Medicine | 1950 E 89th Street, Cleveland, OH 44195-1003 | 2015-04-09 |
1184927287 | Range Health Care Services LLC | Internal Medicine | 4875 Union Rd, Franklin, OH 45005-5127 | 2010-12-10 |
1366622623 | Peter Dillard Md Inc | Internal Medicine | 3237 Ormond Rd, Cleveland Heights, OH 44118-3415 | 2007-11-05 |
1427261692 | Preeti Betkerur | Internal Medicine | 75th Arch St, Suite G 2, Akron, OH 44304 | 2007-05-07 |
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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.