Kenneth Mark MD PC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

204164 Issued in NY

Legal business name

KENNETH MARK MD PC

Practice address

425 County Road 39a Ste 201
Southampton, NY 11968-5246

Phone

(631) 283-0002

Fax

(631) 283-1932

NPI assigned

Jan 23, 2008

Organization subpart

Yes

Parent organization

KENNETH MARK M.D. PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Andre Mark, MDNPI 1538199310

Title

Physician

Phone

(631) 283-0002

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Kenneth Mark MD PC

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Andre Mark, M.D.

  • MOHS-Micrographic Surgery Physician
  • Southampton, NY
  • NPI 1538199310

  Dermatology

  Medicare reassignment Care Compare group NPD Authorized official
• Glenn Donatelli

  • Adult Health Nurse Practitioner
  • Sayville, NY
  • NPI 1588372296
  Medicare reassignment Care Compare group NPD
• Peter Michalos

  • Ophthalmology Physician
  • Southampton, NY
  • NPI 1528094414
  Medicare reassignment NPD
• Wendy Wei-Yue Lou, MD

  • MOHS-Micrographic Surgery Physician
  • Huntington, NY
  • NPI 1629054754

  Dermatology

  NPD
• Louis N. Vogel, M.D.

  • Dermatology Physician
  • New York, NY
  • NPI 1639284128
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1992982748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 175",
            "city": "WATER MILL",
            "state": "NY",
            "postal_code": "119760175",
            "telephone_number": "631-283-0002",
            "fax_number": "631-283-1932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 COUNTY ROAD 39A STE 201",
            "city": "SOUTHAMPTON",
            "state": "NY",
            "postal_code": "119685246",
            "telephone_number": "631-283-0002",
            "fax_number": "631-283-1932"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Pantigo Pl Ste N",
            "address_purpose": "LOCATION",
            "city": "East Hampton",
            "state": "NY",
            "postal_code": "119375923",
            "country_code": "US",
            "telephone_number": "631-283-0292",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "155 Spring St Fl 4",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100125208",
            "country_code": "US",
            "telephone_number": "631-283-0292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KENNETH MARK MD PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNETH MARK M.D. PC",
        "enumeration_date": "2008-01-23",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "MARK",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ANDRE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "631-283-0002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NY",
            "license": "204164",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "204164",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NY",
            "license": "204164",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Michael Kaufman, PH.D.
• Sukhjeet Kaur, DO
• George D Keckeisen, MD
• Alexandra Keenan, M.S. CCC-SLP
• Kathryn Keep
• Michelle Scarcello Kerrigan
• Nazish B Khalid, SRNA, RN
• Saffa Khalid, MD
• Chelsea Corso Kilgore, MS, RD, CDN
• Sunghyun Kim

• MOHS-Micrographic Surgery Physician in Southampton, NY
• Providers in Southampton, NY by specialty
• MOHS-Micrographic Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.