LICKING MEMORIAL PROFESSIONAL CORP. (NPI# 1669547824) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669547824 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORP. |
| Other Organization Name | LICKING MEMORIAL PEDIATRICS EAST |
| Practice Address |
399 E Main St Newark OH 43055-6516 |
| Practice Telephone | 7403481840 |
| Practice Fax Number | 7403481841 |
| Mailing Telephone | 7403481840 |
| Mailing Fax Number | 7403481841 |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ROBERT A. MONTAGNESE (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 7403484027 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Pediatrics East | 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 |
| 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 |
| 1649290073 | Licking Memorial Professional Corp. | Internal Medicine | 120 Mcmillen Dr, Newark, OH 43055-1809 | 2006-07-20 |
| 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 |
399 E MAIN ST |
| City | NEWARK |
| State | OH |
| Zip Code | 43055-6516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144228131 | Katrina M Timson | Family Medicine | 399 E Main St, Newark, OH 43055-6516 | 2005-07-13 |
| 1700050309 | Brian Todd Klima | Pediatrics | 399 E Main St, Newark, OH 43055-6516 | 2008-04-15 |
| 1417030701 | Leslie A. Dieterich | Nurse Practitioner | 399 E Main St, Newark, OH 43055-6516 | 2006-10-23 |
| 1073531729 | Licking Memorial Professional Corp | Family Medicine | 399 E Main St, Newark, OH 43055-6516 | 2006-07-18 |
| 1851399620 | Diane Lemay | Pediatrics | 399 E Main St, Newark, OH 43055-6516 | 2005-07-14 |
| 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 | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578084448 | Valerie Louissaint | Pediatrics | 240 Osborne Ter, Newark, NJ 07112-2130 | 2017-06-30 |
| 1396129912 | Madheea Siddiqi | Pediatrics | 185 S Orange Ave # 972-6015, Newark, NJ 07103-2757 | 2015-07-14 |
| 1124433024 | Priyanka Vakati | Pediatrics | 4755 Ogletown Stanton Rd Dept Of, Newark, DE 19718-2200 | 2014-06-30 |
| 1588920854 | Stephanie J Lempel | Pediatrics | 185 South Orange Avenue - F603, Newark, NJ 07103 | 2012-04-11 |
| 1427360577 | Rula Nassar | Pediatrics | 4755 Ogletown - Stanton Rd, Map Suite 217, Newark, DE 19713 | 2010-07-06 |
| 1235450883 | Jimisha Patel | Pediatrics | 1864 Tamarack Road, Newark, OH 43055 | 2010-06-17 |
| 1235463548 | First State Pediatrics, LLC | Pediatrics | 210 Christiana Medical Ctr, Newark, DE 19702-1652 | 2009-09-21 |
| 1528224615 | Juan Gadea | Pediatrics | 179 W Chestnut Hill Rd Ste 6, Newark, DE 19713-2210 | 2008-07-29 |
| 1821269630 | Chandra Gupta | Pediatrics | 156 Roseville Avenue, Newark, NJ 07107 | 2008-03-19 |
| 1669676219 | Justin M. D'antuono | Pediatrics | 1400 Peoples Plaza, Suite 300, Newark, DE 19702-5708 | 2007-06-14 |
| 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.