| Main Street Pediatrics Pc | |
|
401 S Main St Suite C5 Alpharetta GA 30009-7960 | |
| (678) 205-2437 | |
| (678) 205-2439 |
| Full Name | Main Street Pediatrics Pc |
|---|---|
| Speciality | Pediatrics |
| Location | 401 S Main St, Alpharetta, Georgia |
| Authorized Official Name and Position | Maribel Labindalawa Angka Servera (PHYSICIAN) |
| Authorized Official Contact | 6782052437 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Pediatrics Pc 401 S Main St Suite C5 Alpharetta GA 30009-7960 Ph: (678) 205-2437 | Main Street Pediatrics Pc 401 S Main St Suite C5 Alpharetta GA 30009-7960 Ph: (678) 205-2437 |
| NPI Number | 1619155306 |
|---|---|
| Provider Enumeration Date | 02/05/2008 |
| Last Update Date | 01/22/2009 |
| Medicare PECOS PAC ID | 5496803272 |
|---|---|
| Medicare Enrollment ID | O20090505000276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619155306 | NPI | - | NPPES |
| 000860054D | Medicaid | GA | |
| 000884804C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 047657 (Georgia) | Secondary |
| 208000000X | Pediatrics | 047388 (Georgia) | Primary |
| Provider Name | Maribel L Angka-servera |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932162989 PECOS PAC ID: 3870590094 Enrollment ID: I20070106000139 |
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