Provider Demographics
NPI:1578774766
Name:OLSEN, TREVOR MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:MICHAEL
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TIMBERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:PA
Mailing Address - Zip Code:16345-4150
Mailing Address - Country:US
Mailing Address - Phone:814-757-5860
Mailing Address - Fax:
Practice Address - Street 1:10 TIMBERVIEW LN
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:PA
Practice Address - Zip Code:16345-4150
Practice Address - Country:US
Practice Address - Phone:814-757-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443414208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology