Individual
KENNETH ANDRE MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
365 COUNTY ROAD 39A, SUITE 14, SOUTHAMPTON, NY 11968-5284
(631) 283-0002
(631) 283-1932
Mailing address
PO BOX 175, WATER MILL, NY 11976-0175
(631) 283-0002
(631) 283-1932
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
204164
NY
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
204164
NY
207NS0135X
Procedural Dermatology Physician
204164
NY
Other
Enumeration date
07/04/2006
Last updated
09/12/2012
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