Basic Information
| Provider Information | |||||||||
| NPI: | 1316950314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASLEY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | |||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 ROCKLAND RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514200 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 09/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 029275 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080N0001X | MD434220 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2059761 | 01 | CT | AETNA - NON-PAR ID | OTHER | TIN | 01 | GREAT WEST | OTHER | 765694 | 01 | CT | CONNECTICARE | OTHER | 010029275CT03 | 01 | CT | ANTHEM BC/BS | OTHER | TIN | 01 | UNITED HEALTHCARE | OTHER | 0V2167 | 01 | CT | HEALTH NET | OTHER | P1038298 | 01 | CT | OXFORD HEALTH PLAN | OTHER |