Healthcare Provider Details

I. General information

NPI: 1033173471
Provider Name (Legal Business Name): MIKHAIL J ARTAMONOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date: 09/13/2019
Reactivation Date: 09/25/2019

III. Provider practice location address

391 E BROWN ST
EAST STROUDSBURG PA
18301-9101
US

IV. Provider business mailing address

391 E BROWN ST
EAST STROUDSBURG PA
18301-9101
US

V. Phone/Fax

Practice location:
  • Phone: 570-872-9800
  • Fax: 570-872-9888
Mailing address:
  • Phone: 570-872-9800
  • Fax: 570-872-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD484898
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD484898
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number250059
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD484898
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD484898
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME100837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: