Provider Demographics
NPI:1093102220
Name:PETERSEN, TYLER DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DANIEL
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 5TH AVE STE 1010
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3221
Mailing Address - Country:US
Mailing Address - Phone:412-605-3252
Mailing Address - Fax:
Practice Address - Street 1:3471 5TH AVE STE 1010
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3221
Practice Address - Country:US
Practice Address - Phone:412-605-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-26
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021869207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma