Basic Information
| Provider Information | |||||||||
| NPI: | 1225035975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASEK | ||||||||
| FirstName: | COLETTE | ||||||||
| MiddleName: | REBECCA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 97 PROGRESS BLVD | ||||||||
| Address2: | |||||||||
| City: | SHIPPENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172579053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176944 | ||||||||
| FaxNumber: | 7172176955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD034184E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 334396 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 60068465 | 01 | PA | RAILROAD MEDICARE | OTHER | 001206690 | 05 | PA | MEDICAID | 1521308 | 01 | PA | GATEWAY | OTHER | 1752602 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 2804527 | 01 | PA | AETNA | OTHER |