Provider Demographics
NPI:1346849205
Name:GASPAROTTO, VINCENT ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:ROBERT
Last Name:GASPAROTTO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 WOODLAND GLEN DR APT 204
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2445
Mailing Address - Country:US
Mailing Address - Phone:248-961-2768
Mailing Address - Fax:
Practice Address - Street 1:22990 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1641
Practice Address - Country:US
Practice Address - Phone:248-667-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant