OrganizationActive
Licking Memorial Professional Corp
NPI 1497937510 · Geriatric Medicine (Family Medicine) Physician · Newark, OH
Provider details
- NPI number
- 1497937510
- Entity type
- Organization
- Primary specialty
- Geriatric Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Thomas Poulson, Cfo
Practice location
1450 W Main St
Newark, OH 43055-1825
Phone: (740) 348-7935
Fax: (740) 348-7936
Mailing address
1450 W Main St
Newark, OH 43055-1825
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.