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KENNETH ANDRE MARK M.D. NPI 1538199310


NPI Information

NPI: 1538199310
Provider Name: KENNETH ANDRE MARK, M.D.
Classification: Dermatology - 207ND0101X
Entity Type: Individual

Specialization: MOHS-Micrographic Surgery

PECOS Registration: Yes

CLIA Number: 33D1031432

Address:
365 COUNTY ROAD 39A
SUITE 14
SOUTHAMPTON, NY
ZIP 11968
Phone: (631) 283-0002
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Kenneth Andre Mark, M.D. is a mohs-micrographic surgery dermatology in Southampton, NY with 29 years of experience. The provider is the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. Kenneth Andre Mark, M.D. NPI is 1538199310. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: STATE UNIVERSITY OF NY UPSTATE MEDICAL UNIVERSITY
Graduation Year:1995

The provider's business location address is:

365 COUNTY ROAD 39A
SUITE 14
SOUTHAMPTON, NY
ZIP 11968-284
Phone: (631) 283-0002
Fax: (631) 283-1932

The NPI 1538199310 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The CLIA number assigned to this NPI record is 33D1031432 - physician office with a certificate type of Certificate of Compliance.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Destruction of 2-14 skin growths (HCPCS:17003)
  • Tangential biopsy of single skin lesion (HCPCS:11102)
  • Tangential biopsy of additional skin lesion (HCPCS:11103)
  • Destruction of skin growth (HCPCS:17000)
  • Removal and microscopic examination of growth of the head, neck, hands, feet, or genitals (first stage, up to 5 tissue blocks) (HCPCS:17311)
  • Removal and microscopic examination of growth of the trunk, arms, or legs (first stage, up to 5 tissue blocks) (HCPCS:17313)
  • Removal and microscopic examination of growth of the head, neck, hands, feet, or genitals (HCPCS:17312)
  • Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs (HCPCS:13121)
  • Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (HCPCS:13132)

The enumeration date for this NPI number is 7/4/2006 and was last updated on 9/12/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatology204164NEW YORKNo
2207NS0135XDermatologyProcedural Dermatology204164NEW YORKNo
3207ND0101XDermatologyMOHS-Micrographic Surgery204164NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1H34850MEDICARE UPINNEW YORK
22K3301MEDICARE ID-TYPE UNSPECIFIEDNEW YORK
3WZYPV1MEDICARE UPINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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