Provider Demographics
NPI:1750416491
Name:ROBINSON, NICOLAS EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:EDWARD
Last Name:ROBINSON
Suffix:
Gender:M
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: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:336-277-4075
Mailing Address - Fax:336-277-4095
Practice Address - Street 1:7210 VILLAGE MEDICAL CIR STE 310
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8041
Practice Address - Country:US
Practice Address - Phone:336-277-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200700570208600000X
NC2007-00570208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2007-00570OtherSTATE LICENSE
NC5907896Medicaid
BR9860633OtherDEA NUMBER
BR9860633OtherDEA NUMBER