Individual
CAROLYN H REVERCOMB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 ELIZABETH BLACKWELL ST, SYRACUSE, NY 13210-2303
(315) 435-3163
Mailing address
401 S SALINA ST APT 506, SYRACUSE, NY 13202-2563
(571) 217-6440
Taxonomy
Speciality
Code
Description
License number
State
207ZF0201X
Forensic Pathology Physician
Primary
202191
NY
Other
Enumeration date
01/26/2020
Last updated
01/26/2020
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