KENNETH MARK MD PC
NPI 1992982748
Dermatology - MOHS-Micrographic Surgery in Southampton, NY

Q: What is Kenneth Mark MD PC's NPI number?

The NPI number for Kenneth Mark MD PC is 1992982748. It was assigned to this organization in the NPPES registry on January 23, 2008.

Q: What is Kenneth Mark MD PC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Active since January 23, 2008

425 COUNTY ROAD 39A STE 201, SOUTHAMPTON, NY 11968(631) 283-0002(631) 283-1932 Get Directions Write a Review

NPPES record last updated: May 26, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Kenneth Mark Md Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNETH MARK MD PC (NPI 1992982748) is a healthcare organization registered as a mohs-micrographic surgery in Southampton, New York and active in the NPI registry since January 2008. The organization maintains 2 additional practice locations and lists Kenneth Andre Mark, Physician, as its authorized official.

NPPES Registry Identity

NPI1992982748

Entity TypeOrganization

Primary Taxonomy207ND0101X

Legal Business NameKENNETH MARK MD PC

Location Address425 COUNTY ROAD 39A STE 201Southampton, NY 11968-5246

Mailing AddressPo Box 175Water Mill, NY 11976-0175 · (631) 283-0002 · Fax (631) 283-1932

Phone(631) 283-0002

Fax(631) 283-1932

Organization SubpartYesParent: Kenneth Mark M.d. Pc

Authorized OfficialKenneth Andre MarkPhysician · (631) 283-0002

Enumeration DateJanuary 23, 2008

Last NPPES UpdateMay 26, 2026

NPPES CertifiedMay 26, 2026

✔ NPI 1992982748 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207ND0101X

License✔ Licensed in NY · 204164

Definition

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.

Also ListedDermatologyTaxonomy 207N00000X · License 204164 (NY)

Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X · License 204164 (NY)

425 COUNTY ROAD 39A STE 201, Southampton, NY 11968

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Secondary Practice Locations 2

Location 1200 Pantigo Pl Ste NEast Hampton, NY 11937-5923 · Phone (631) 283-0292

Location 2155 Spring St Fl 4New York, NY 10012-5208 · Phone (631) 283-0292

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth Mark Md Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 3 clinicians reassign Medicare billing to Kenneth Mark MD PC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Kenneth Mark, M.D.

Dermatology

NPI 1538199310

365 COUNTY ROAD 39A SUITE 14
Southampton, NY 11968

(631) 283-0002

✔ PECOS✔ Accepts Medicare0.1 mi

Peter Michalos

Ophthalmology

NPI 1528094414

365 COUNTY ROAD 39A
Southampton, NY 11968

(631) 283-8604

✔ PECOS✔ Accepts Medicare0.1 mi

Glenn Donatelli

Nurse Practitioner

NPI 1588372296

43 BROADWAY AVE
Sayville, NY 11782

(631) 398-8568

✔ PECOS✔ Accepts Medicare37 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenneth Mark MD PC's NPI number?

The NPI number for Kenneth Mark MD PC is 1992982748. It was assigned to this organization in the NPPES registry on January 23, 2008.

Where is Kenneth Mark MD PC located?

Kenneth Mark MD PC is located at 425 County Road 39A Ste 201, Southampton, NY 11968. The listed phone number is (631) 283-0002.

What is Kenneth Mark MD PC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Kenneth Mark MD PC enrolled in Medicare?

Yes. Kenneth Mark MD PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kenneth Mark MD PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Kenneth Mark MD PC, in Dermatology, Nurse Practitioner and Ophthalmology. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Kenneth Mark MD PC was last updated on May 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.