Provider Demographics
NPI:1225045602
Name:ROBINSON, LASEAN BOST (MD)
Entity Type:Individual
Prefix:MRS
First Name:LASEAN
Middle Name:BOST
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LASEAN
Other - Middle Name:NICOLE
Other - Last Name:BOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-7080
Mailing Address - Fax:336-718-9622
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-7080
Practice Address - Fax:336-718-9622
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601049207R00000X
NC2006-01049208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335816OtherMEDICARE PTAN, C.HOSP.GRP.WILKES
NCNC2594BOtherMEDICARE PTAN, INDIVIDUAL