OrganizationActive
Licking Memorial Professional Corp.
NPI 1235311358 · Geriatric Medicine (Family Medicine) Physician · Newark, OH
Provider details
- NPI number
- 1235311358
- Entity type
- Organization
- Primary specialty
- Geriatric Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Thomas Poulson, Cfo(740) 348-4110
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
17 Forry St
Newark, OH 43055-4004
Phone: (740) 348-7935
Fax: (740) 348-7936
Approximate (ZIP-level) locationGet directions
Mailing address
17 Forry St
Newark, OH 43055-4004
Other names (DBA / former)
- Doing business as
- Licking Memorial Geriatric Medicine at Autumn
Registry dates
- Enumerated
- 2007-11-30
- Last updated
- 2007-11-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.