LICKING MEMORIAL PROFESSIONAL CORPORATION (NPI# 1700291416) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700291416 |
| Entity Type | Organization |
| Organization Name | LICKING MEMORIAL PROFESSIONAL CORPORATION |
| Other Organization Name | LICKING MEMORIAL DERMATOLOGY PATASKALA |
| Practice Address |
1 Healthy Pl Suite 205 Pataskala OH 43062-7067 |
| Practice Telephone | 7403481930 |
| Practice Fax Number | 7403481931 |
| Mailing Telephone | 7403481930 |
| Mailing Fax Number | 7403481931 |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2014-06-23 |
| Authorized Official Name | CYNTHIA L. WEBSTER (VP FINANCIAL SERVICES) |
| 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 | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Licking Memorial Dermatology Pataskala | 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 |
| 1740623628 | Licking Memorial Professional Corporation | Internal Medicine | 1272 West Main Street Bldg 2, Ste 4, Newark, OH 43055 | 2013-04-10 |
| 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 |
| 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 |
1 HEALTHY PL SUITE 205 |
| City | PATASKALA |
| State | OH |
| Zip Code | 43062-7067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427056597 | John Applegate | Pediatrics | 1 Healthy Pl, Ste. 203, Pataskala, OH 43062-7067 | 2005-07-12 |
| 1952479115 | Connie S Jenkins | Psychiatry & Neurology | 1 Healthy Pl, Suite 105, Pataskala, OH 43062-7067 | 2006-12-04 |
| 1295809614 | Licking Memorial Professional Corp. | Psychiatry & Neurology | 1 Healthy Pl, Suite 105, Pataskala, OH 43062-7067 | 2006-11-17 |
| 1235159674 | Licking Memorial Professional Corp. | Obstetrics & Gynecology | 1 Healthy Pl, Suite 103, Pataskala, OH 43062-7067 | 2006-07-20 |
| 1144240581 | Licking Memorial Professional Corp. | Pediatrics | 1 Healthy Pl, Ste 203, Pataskala, OH 43062 | 2006-07-20 |
| 1851325526 | Licking Memorial Professional Corp | Family Medicine | 1 Healthy Pl, Suite 101, Pataskala, OH 43062-7067 | 2006-07-10 |
| 1104869700 | Tiffany E.d. Inglis | Obstetrics & Gynecology | 1 Healthy Pl, Suite 201, Pataskala, OH 43062-7067 | 2006-06-13 |
| 1942249735 | Dalia S Elkhairi | Obstetrics & Gynecology | 1 Healthy Pl, Suite 201, Pataskala, OH 43062-7067 | 2006-06-06 |
| 1255330965 | Colleen Smith | Family Medicine | 1 Healthy Pl, Suite 101, Pataskala, OH 43062-7067 | 2005-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255955639 | 1st and Long Logistics Ltd. | Private Vehicle | 104 Eastave, Pataskala, OH 43062 | 2020-06-02 |
| 1023639168 | Jodi C Neff | Driver | 104 East Ave, Etna, OH 43062 | 2020-04-29 |
| 1073022596 | Bonny Lou Harris | Licensed Vocational Nurse | 8764 National Rd Sw Lot 43, Pataskala, OH 43062 | 2017-09-27 |
| 1780131359 | Patricia Obrien | Licensed Practical Nurse | 4606 Brownstone Drive, Hilliard, OH 43062 | 2016-09-01 |
| 1477941615 | Keli R Massie | Speech-Language Pathologist | 391 S. High Street, Pataskala, OH 43062 | 2014-12-22 |
| 1952709016 | Stacey Heldman | Speech-Language Pathologist | 927b South St., Etna, OH 43062 | 2014-12-05 |
| 1033541842 | Power Ahead Physical Therapy LLC | Physical Therapist | 202 E. Broad St., Pataskala, OH 43062 | 2013-08-02 |
| 1174819288 | Mollie Sue Albaugh | Occupational Therapy Assistant | 14 Milkweed Place, Pataskala, OH 43062 | 2011-06-27 |
| 1710198619 | Jennifer Agnes Skeens | Licensed Practical Nurse | 114 Deer Path Ct N, Pataskala, OH 43062 | 2007-05-24 |
| 1346456357 | Total Renal Care Inc | Clinic/Center | 658 E Broad St, Pataskala, OH 43062 | 2007-05-15 |
| Find all providers in zip 43062 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326047028 | Laura Schaeffer | Dermatology | One Healthy Place, Ste 205, Pataskala, OH 43062 | 2005-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023623808 | Bria Deshea Barjuca | Dermatology | 4450 Eastgate Blvd Ste 232, Cincinnati, OH 45245-1788 | 2020-09-09 |
| 1184263675 | Sunkiss Essentials LLC | Dermatology | 2926 State Rd Ste 369, Cuyahoga Falls, OH 44223-1244 | 2019-12-31 |
| 1770048894 | Teresa O'connell | Dermatology | Timeless Skin Solutions, 31 South High St, Dublin, OH 43017 | 2019-02-02 |
| 1144737560 | Robert Brody Md Co | Dermatology | 3461 Warrensville Center Rd Ste 101, Shaker Heights, OH 44122-5227 | 2018-01-08 |
| 1366893752 | Kirsten Dickinson | Dermatology | Cleveland Clinic 9500 Euclin Ave, Cleveland, OH 44195-1009 | 2016-06-27 |
| 1649629692 | Megan Ashley Jones-sheets | Dermatology | 75 Metro Place North, Suite 195, Dublin, OH 43017 | 2016-06-10 |
| 1275982746 | Samantha N Barry | Dermatology | 9403 Kenwood Rd Ste B100, Blue Ash, OH 45242-6858 | 2016-06-06 |
| 1720433592 | Nitin Tiwari | Dermatology | 4439 State Route 159 Ste G50, Chillicothe, OH 45601-7202 | 2016-04-29 |
| 1487008751 | Kiyanna Marie Williams | Dermatology | 2049 E 100th St A Building, Cleveland, OH 44195-1014 | 2016-04-22 |
| 1336502038 | Jacqueline Graham | Dermatology | 566 White Pond Dr Ste E, Akron, OH 44320-1116 | 2016-03-30 |
| Find all providers with the same taxonomy | ||||
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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.