Provider Demographics
NPI:1184680605
Name:PITHAN, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:PITHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4700 E 56TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2904
Mailing Address - Country:US
Mailing Address - Phone:563-421-0480
Mailing Address - Fax:563-421-0489
Practice Address - Street 1:4700 E 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2904
Practice Address - Country:US
Practice Address - Phone:563-421-0480
Practice Address - Fax:563-421-0489
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-446902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology