MEDICARE: DR. TREVOR MICHAEL OLSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	MD443414	PA

General Provider Information

NPI Number	:	1578774766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR MICHAEL OLSEN M.D.

Provider Business Mailing Address
First Line	:	10 TIMBERVIEW LN
Second Line	:
City	:	RUSSELL
State	:	PA
Zip	:	16345-4150
Country	:	US
Telephone Number	:	814-757-5860
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 TIMBERVIEW LN
Second Line	:
City	:	RUSSELL
State	:	PA
Zip	:	16345-4150
Country	:	US
Telephone Number	:	814-757-5860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2007
Last Update Date	:	08/12/2020

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