Provider Demographics
NPI:1982869327
Name:CLAYTON, LARISSA MARIE GASPARATO (DO)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:MARIE GASPARATO
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LARISSA
Other - Middle Name:MARIE
Other - Last Name:GASPARATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:503 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2204
Mailing Address - Country:US
Mailing Address - Phone:717-972-4300
Mailing Address - Fax:
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMPHILL
Practice Address - State:PA
Practice Address - Zip Code:17401-3349
Practice Address - Country:US
Practice Address - Phone:717-972-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012563207P00000X
PAOS015268207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine