Healthcare Provider Details

I. General information

NPI: 1225035975
Provider Name (Legal Business Name): COLETTE REBECCA LASEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 PROGRESS BLVD
SHIPPENSBURG PA
17257-9053
US

IV. Provider business mailing address

785 5TH AVE STE 3
CHAMBERSBURG PA
17201-4232
US

V. Phone/Fax

Practice location:
  • Phone: 717-217-6944
  • Fax: 717-217-6955
Mailing address:
  • Phone: 717-263-9555
  • Fax: 717-709-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD034184E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: