Healthcare Provider Details

I. General information

NPI: 1790589851
Provider Name (Legal Business Name): TREVOR AUSTIN LOSEGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 EASTON AVE
BETHLEHEM PA
18017-4204
US

IV. Provider business mailing address

2830 EASTON AVE
BETHLEHEM PA
18017-4204
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-3555
  • Fax: 833-822-5230
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT233282
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: