Provider Demographics
NPI:1205083284
Name:PANIAGUA, TIZIANA (MD)
Entity type:Individual
Prefix:
First Name:TIZIANA
Middle Name:
Last Name:PANIAGUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIZIANA
Other - Middle Name:PANIAGUA
Other - Last Name:NAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1085 NORTHEAST GATEWAY COURT NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2412
Mailing Address - Country:US
Mailing Address - Phone:704-403-8650
Mailing Address - Fax:704-403-8655
Practice Address - Street 1:1085 NORTHEAST GATEWAY COURT NE
Practice Address - Street 2:SUITE 200
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2412
Practice Address - Country:US
Practice Address - Phone:704-403-8650
Practice Address - Fax:704-403-8655
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009OtherMEDICARE, ENTITY PTAN
NC5910501Medicaid
NC2022948Medicare PIN
NCNCF981C904Medicare PIN