OrganizationActive
Licking Memorial Professional Corporation
NPI 1093757155 · Family Medicine Physician · Newark, OH
Provider details
- NPI number
- 1093757155
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Robert Montagnese, Executive Vice President(740) 348-4000
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
150 Mcmillen Dr
Newark, OH 43055-1811
Phone: (740) 348-4827
Fax: (740) 348-1894
Street-level locationGet directions
Mailing address
150 Mcmillen Dr
Newark, OH 43055-1811
Other names (DBA / former)
- Doing business as
- Licking Memorial Family Practice
Registry dates
- Enumerated
- 2006-06-12
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.