Provider Demographics
NPI:1376750646
Name:LILES, NANCY LAURA (DO)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LAURA
Last Name:LILES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 MCCONNELL RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3241
Mailing Address - Country:US
Mailing Address - Phone:540-366-6729
Mailing Address - Fax:540-265-7083
Practice Address - Street 1:7455 MCCONNELL RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3241
Practice Address - Country:US
Practice Address - Phone:540-366-6729
Practice Address - Fax:540-265-7083
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036988204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
286206OtherANTHEM BCBS
E27143Medicare UPIN