Provider Demographics
NPI:1932162989
Name:ANGKA-SERVERA, MARIBEL LABINDALAWA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:LABINDALAWA
Last Name:ANGKA-SERVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:SERVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:SUITE C5
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7960
Mailing Address - Country:US
Mailing Address - Phone:678-205-2437
Mailing Address - Fax:678-205-2439
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:SUITE C5
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7960
Practice Address - Country:US
Practice Address - Phone:678-205-2437
Practice Address - Fax:678-205-2439
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000860054DMedicaid