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

Tyler Gavin Petersen, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1992557383

Tyler Gavin Petersen, MD is a Student in an Organized Health Care Education/Training Program in Cooperstown, New York. Registered with an NPI since 2024.

In the registry since
2024
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

1 Atwell Rd
Cooperstown, NY 13326-1301
Phone: (607) 547-3456
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1992557383
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 1, 2024
Last updated in NPPESApril 27, 2024
Certification dateApril 27, 2024

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