Provider Demographics
NPI:1124135397
Name:PANTEA, LILIANA (MD)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:PANTEA
Suffix:
Gender:F
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 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:888-987-1151
Mailing Address - Fax:
Practice Address - Street 1:1115 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5627
Practice Address - Country:US
Practice Address - Phone:336-910-9300
Practice Address - Fax:888-355-6861
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEC081002207Q00000X
ME017796207Q00000X
NC2016-02252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432681199Medicaid
MENONEOtherRESIDENT-NO PROV #