OrganizationActive
Licking Memorial Professional Corporation
NPI 1831381706 · Plastic and Reconstructive Surgery Physician · Newark, OH
Provider details
- NPI number
- 1831381706
- Entity type
- Organization
- Primary specialty
- Plastic and Reconstructive Surgery PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Renee Spring-Ives, Credentialing Coordinator(740) 348-4027
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1272 W Main St
Bldg. 2
Newark, OH 43055-2004
Phone: (740) 348-7955
Fax: (740) 348-7956
Approximate (ZIP-level) locationGet directions
Mailing address
1272 W Main St
Newark, OH 43055-2004
Other names (DBA / former)
- Doing business as
- Licking Memorial Reconstructive & Cosmetic Services
Registry dates
- Enumerated
- 2007-08-15
- Last updated
- 2007-08-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.