Provider Demographics
NPI:1871594234
Name:COVENEY, CAROLYN L (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:COVENEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2856
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-476-1792
Practice Address - Street 1:308 W SENECA ST
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-2318
Practice Address - Country:US
Practice Address - Phone:315-682-5080
Practice Address - Fax:315-682-8847
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-11-09
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Provider Licenses
StateLicense IDTaxonomies
NY189998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01359975Medicaid
NYJ400045921Medicare PIN