Provider Demographics
NPI:1104830165
Name:PANTEA, CRISTIAN EMANUIL (MD)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:EMANUIL
Last Name:PANTEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4725
Mailing Address - Country:US
Mailing Address - Phone:704-671-5311
Mailing Address - Fax:704-671-5308
Practice Address - Street 1:209 PARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-5205
Practice Address - Country:US
Practice Address - Phone:704-671-7411
Practice Address - Fax:704-825-6985
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904499Medicaid
SCN0111BMedicaid
SCN0111BMedicaid
NC5904499Medicaid