Healthcare Provider Details

I. General information

NPI: 1649772195
Provider Name (Legal Business Name): STEVEN ARCHAMBAULT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MADISON AVENUE
SCRANTON PA
18510
US

IV. Provider business mailing address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3814
US

V. Phone/Fax

Practice location:
  • Phone: 570-343-2383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT018315
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: