Provider Demographics
NPI:1568718674
Name:TAIT, DONALD (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:TAIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 LEGACY OAKS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6557
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:
Practice Address - Street 1:162 LEGACY OAKS DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6556
Practice Address - Country:US
Practice Address - Phone:919-373-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011554207Q00000X
NMA-1939-16207Q00000X
NC2020-00625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114157Medicaid
31-0564121OtherGRANDVIEW HOSPITAL
OH31-1175717OtherALLIANCE PHYSICIANS