Waterboro Village Pediatrics LLC PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

WATERBORO VILLAGE PEDIATRICS LLC PA

Practice address

43 Sokokis Trail
East Waterboro, ME 04030

Phone

(207) 247-6742

Fax

(207) 247-6114

NPI assigned

Jan 19, 2006

Last updated

May 7, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keasha Danielle Marescot, MDNPI 1275503922

Title

Co Owner Partner

Phone

(207) 247-6742

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12090/brand/1/csg/1/fhir/r4

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keasha Danielle Marescot, MD

  • Pediatrics Physician
  • E Waterboro, ME
  • NPI 1275503922
  Authorized official Same address or phone
• Laura Jean Bickford, DNP, FNP-BC

  • Nurse Practitioner
  • East Waterboro, ME
  • NPI 1417482936
  NPD (past)
• Jason Alexander Lange

  • Family Nurse Practitioner
  • East Waterboro, ME
  • NPI 1699449082
  NPD (past)
• Erin Susan Welch, PAC

  • Physician Assistant
  • Kennebunk, ME
  • NPI 1396823241
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1225018740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1849",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042411849",
            "telephone_number": "207-784-2554",
            "fax_number": "207-777-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 SOKOKIS TRAIL",
            "city": "EAST WATERBORO",
            "state": "ME",
            "postal_code": "04030",
            "telephone_number": "207-247-6742",
            "fax_number": "207-247-6114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERBORO VILLAGE PEDIATRICS LLC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "MARESCOT",
        "authorized_official_first_name": "KEASHA",
        "authorized_official_middle_name": "DANIELLE",
        "authorized_official_title_or_position": "CO OWNER PARTNER",
        "authorized_official_telephone_number": "207-247-6742",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30213870",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157150000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Selective Care Solutions
• Southern Maine Health Care
• Natacha J Sovetsky-Chabot, NP
• Sarah M Sylvestre, RN
• Mary P Walsh, DO
• Jaclyn Zubiate, APRN-CNP

• Pediatrics Physician in East Waterboro, ME
• Providers in East Waterboro, ME by specialty
• Pediatrics Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.