Provider Demographics
NPI:1669457545
Name:GROBAN, LEANNE (MD)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:GROBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-9715
Mailing Address - Country:US
Mailing Address - Phone:284-660-4668
Mailing Address - Fax:828-466-8862
Practice Address - Street 1:3975 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-9715
Practice Address - Country:US
Practice Address - Phone:284-660-4668
Practice Address - Fax:828-466-8862
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600931207L00000X, 207LP2900X, 207LH0002X
WI75455-20207LH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
23273OtherPARTNERS
NC891131CMedicaid
SCQ60931Medicaid
1131COtherBCBS
WV2004782000Medicaid
VA5714346Medicaid
7808326OtherAETNA
79213OtherMEDCOST
SCQ60931Medicaid