Main Street Internal Medicine & Pediatrics PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

047388 Issued in GA

Legal business name

MAIN STREET INTERNAL MEDICINE & PEDIATRICS PC

Practice address

401 S Main St
Suite C5
Alpharetta, GA 30009-7960

Phone

(678) 205-2437

Fax

(678) 205-2439

NPI assigned

Feb 5, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Maribel Labindalawa Angka Servera, MDNPI 1932162989

Title

Physician

Phone

(678) 205-2437

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Main Street Pediatrics PC Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maribel Labindalawa Angka-Servera, MD

  • Pediatrics Physician
  • Alpharetta, GA
  • NPI 1932162989
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232582400000",
    "number": "1619155306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S MAIN ST",
            "address_2": "SUITE C5",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300097960",
            "telephone_number": "678-205-2437",
            "fax_number": "678-205-2439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S MAIN ST",
            "address_2": "SUITE C5",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300097960",
            "telephone_number": "678-205-2437",
            "fax_number": "678-205-2439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET INTERNAL MEDICINE & PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-05",
        "last_updated": "2009-01-22",
        "status": "A",
        "authorized_official_last_name": "ANGKA SERVERA",
        "authorized_official_first_name": "MARIBEL",
        "authorized_official_middle_name": "LABINDALAWA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "678-205-2437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "047657",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "047388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000860054D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000884804C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Pediatrics PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.