Provider Demographics
NPI:1316950314
Name:LASLEY, LAURA K (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:LASLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4200
Mailing Address - Fax:
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-651-4200
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029275208000000X
PAMD4342202080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2059761OtherAETNA - NON-PAR ID
TINOtherGREAT WEST
CT765694OtherCONNECTICARE
CT010029275CT03OtherANTHEM BC/BS
TINOtherUNITED HEALTHCARE
CT0V2167OtherHEALTH NET
CTP1038298OtherOXFORD HEALTH PLAN