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

Dr. Lauris J Petersen, MD

Individual provider Family Medicine Physician · NPI 1629152301

Dr. Lauris J Petersen, MD is a Family Practice in Glenville, New York. Graduated from Georgetown University School of Medicine in 1995, 31 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in New York.

Years since qualifying
31
Trained at
Georgetown University School of Medicine
Licensed in
NY
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

15 Glenridge Rd
Glenville, NY 12302-4520
Phone: (518) 399-0909
Fax: (518) 399-2640
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 213320 (NY)

Record details

NPI number1629152301
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedOctober 25, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolGEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
Graduated 1995 (31 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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