Provider Demographics
NPI:1790003499
Name:TAIT, MARK ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ADAM
Last Name:TAIT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4301 W MARKHAM ST STE 783
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7199
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-5148
Practice Address - Street 1:4301 W MARKHAM ST STE 531
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7199
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:501-526-5148
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2015-00181207X00000X
ARE-7598207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR209552001Medicaid
NC1790003499Medicaid
SCNC2414Medicaid
NCNCN463AMedicare UPIN