Provider Demographics
NPI:1225035975
Name:LASEK, COLETTE REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:REBECCA
Last Name:LASEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:97 PROGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9053
Practice Address - Country:US
Practice Address - Phone:717-217-6944
Practice Address - Fax:717-217-6955
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034184E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA334396OtherHIGHMARK BLUE SHIELD
PA60068465OtherRAILROAD MEDICARE
PA001206690Medicaid
PA1521308OtherGATEWAY
PA1752602OtherCAPITAL BLUE CROSS
PA2804527OtherAETNA
PA1521308OtherGATEWAY
PA613665ZEN8Medicare PIN