Healthcare Provider Details

I. General information

NPI: 1205028560
Provider Name (Legal Business Name): HERBERT MICHAEL ARCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 W PUTNAM AVE STE 203
GREENWICH CT
06830-6088
US

IV. Provider business mailing address

644 W PUTNAM AVE STE 203
GREENWICH CT
06830-6088
US

V. Phone/Fax

Practice location:
  • Phone: 203-661-2596
  • Fax: 833-941-0867
Mailing address:
  • Phone: 203-661-2596
  • Fax: 833-941-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46754
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number243843
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: