Healthcare Provider Details

I. General information

NPI: 1689865743
Provider Name (Legal Business Name): MICHAEL BRIAN ARCHAMBAULT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET
HARTFORD CT
06106-5539
US

IV. Provider business mailing address

99 EAST RIVER DRIVE 5TH FLOOR
EAST HARTFORD CT
06108-7301
US

V. Phone/Fax

Practice location:
  • Phone: 203-370-1701
  • Fax:
Mailing address:
  • Phone: 860-282-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number047171
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number047171
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: