Provider Demographics
NPI:1700040672
Name:PETERSON, ANDREW CRAIG (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CRAIG
Last Name:PETERSON
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:5500 MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6755
Mailing Address - Country:US
Mailing Address - Phone:716-204-3200
Mailing Address - Fax:716-829-2138
Practice Address - Street 1:5959 BIG TREE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2291
Practice Address - Country:US
Practice Address - Phone:716-204-3200
Practice Address - Fax:716-829-2138
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2016-03-16
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Provider Licenses
StateLicense IDTaxonomies
NY012602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant