Individual
COLETTE REBECCA LASEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
97 PROGRESS BLVD, SHIPPENSBURG, PA 17257-9053
(717) 217-6944
(717) 217-6955
Mailing address
785 5TH AVE STE 3, CHAMBERSBURG, PA 17201-4232
(717) 263-9555
(717) 709-6529
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD034184E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001206690
—
PA
01
—
1521308
GATEWAY
PA
01
—
1752602
CAPITAL BLUE CROSS
PA
01
—
2804527
AETNA
PA
01
—
334396
HIGHMARK BLUE SHIELD
PA
01
—
60068465
RAILROAD MEDICARE
PA
Enumeration date
07/07/2005
Last updated
09/08/2021
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