Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | BK3751460 | FL |
Y | 207N00000X | Dermatologist | ME146752 | FL |
N | 207NS0135X | Procedural Dermatology | 178676-1 | NY |
N | 207NS0135X | Procedural Dermatology | ME146752 | FL |
NPI | 1386648616 |
---|---|
Provider Name | Mark D. Kaufmann |
First Address | Maitland, FL 32751-7172 |
Second Address | New York, NY 10128-0654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 16/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F26424 | (02) | NY |