Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Blake Allan Peterson

Individual provider Emergency Medicine Physician · NPI 1790480549

Blake Allan Peterson is an Emergency Medicine in Buffalo, New York. Graduated from State University of New York at Buffalo School of Medicine in 2023, 3 years ago. Licensed in New York.

Years since qualifying
3
Trained at
State University of New York at Buffalo School of Medicine
Licensed in
NY
In the registry since
2023
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Practice location Address checks out

955 Main St Ste 7230
Buffalo, NY 14203-1121
Phone: (716) 829-2012
Fax: (716) 829-3999
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 343066 (NY)

Record details

NPI number1790480549
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 3, 2023
Last updated in NPPESJuly 31, 2026
Certification dateJuly 31, 2026
Mailing address955 Main St Ste 7230, Buffalo, NY 14203-1121

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolSTATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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