Provider Demographics
NPI:1124135397
Name:PANTEA, LILIANA (MD)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:PANTEA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:LILIANA
Other - Middle Name:
Other - Last Name:RIVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3274 SILAS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:3274 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3010
Practice Address - Country:US
Practice Address - Phone:336-604-2822
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017796207Q00000X
MEEC081002207Q00000X
NC2016-02252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432681199Medicaid
MENONEOtherRESIDENT-NO PROV #