Provider Demographics
NPI:1861019135
Name:ARCHER GERMAN, DIMITRI PHILIPPE (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRI
Middle Name:PHILIPPE
Last Name:ARCHER GERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SEAGIRT BLVD APT 2C
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2823
Mailing Address - Country:US
Mailing Address - Phone:929-523-3846
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2024-01-03
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2023-08-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program