LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1740623628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740623628 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Other Organization Name | LICKING MEMORIAL RHEUMATOLOGY |
| Practice Address |
1272 West Main Street Bldg 2 Ste 4 Newark OH 43055 |
| Practice Telephone | 7403487975 |
| Practice Fax Number | 7403487976 |
| Mailing Telephone | 7403487975 |
| Mailing Fax Number | 7403487976 |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2013-04-10 |
| Authorized Official Name | CYNTHIA L. WEBSTER (VP FINANCIAL SERVICE) |
| Authorized Official Telephone | 7403484518 |
| Is Organization Subpart | Y |
| Parent Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Rheumatology | 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 |
| 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 |
| 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 4 |
| 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 | 207RR0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Rheumatology |
| An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |
| 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 |
|---|---|---|---|---|
| 1124129747 | Douglas Lienesch | Internal Medicine | 4735 Ogletown Stanton Rd Ste 2201, Newark, DE 19713-8000 | 2006-09-26 |
| 1295761310 | Hufza Hanif | Internal Medicine | 1272 W Main St Ste 201, Ste. 4, Newark, OH 43055-2055 | 2006-06-23 |
| 1902340953 | Navya Kuchipudi | Internal Medicine | 166 Lyons Ave, Newark, NJ 07112 | 2016-12-10 |
| 1912308024 | Lydia Esther Cortes Betancourt | Internal Medicine | 1272 W Main St Ste 201, Newark, OH 43055-2055 | 2014-09-08 |
| 1861811952 | Amy Zhang | Internal Medicine | 4735 Ogletown Stanton Rd Ste 2201, Newark, DE 19713-8000 | 2014-04-16 |
| 1972822500 | Pietro V Rocca Md Pa | Internal Medicine | 537 Stanton Christiana Rd, # 101, Newark, DE 19713-2146 | 2010-05-21 |
| 1114963626 | Sheerin Javed | Internal Medicine | 537 Stanton Christiana Rd, Suite 212, Newark, DE 19713-2146 | 2006-06-22 |
| 1497703474 | Joan Kathryn Kowalec | Internal Medicine | 400 Osborne Ter, L-4, Newark, NJ 07112-2046 | 2006-05-04 |
| 1114985702 | Nbimc Department of Internal | Internal Medicine | 201 Lyons Ave, Newark, NJ 07112-2027 | 2006-05-03 |
| 1124023742 | Pietro V. Rocca | Internal Medicine | 537 Stanton Christiana Rd, Ste 101, Newark, DE 19713-2145 | 2005-06-20 |
| 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.