Individual provider · Type 1 NPI

Owen Petersen, PA

Surgical Physician Assistant · Albany, NY

NPI number 1457896300 Active

Practice location

121 Everett Rd
Albany, NY 12205-1474

Call (518) 489-2663 Map

Fax (518) 689-3881

Specialties and licenses

TaxonomyCodeLicense
Athletic Trainer 2255A2300XNone listed
Physician Assistant 363A00000X027272 (NY)
Student in an Organized Health Care Education/Training Program 390200000XNone listed
Surgical Physician Assistant Primary 363AS0400X027272 (NY)

Surgical Physician Assistant: Definition to come...

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About NPI 1457896300

Owen Petersen, PA's National Provider Identifier is 1457896300, issued on Jan 2, 2017. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Albany, NY. The record was last updated on Jul 16, 2025.