Individual
EVANGELINE KOUTALIANOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-5820
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
299948
NY
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
299948
NY
Other
Enumeration date
07/08/2014
Last updated
05/13/2021
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