Provider Demographics
NPI:1801827761
Name:MARK BERNHARDT, MD, PA
Entity Type:Organization
Organization Name:MARK BERNHARDT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-463-3421
Mailing Address - Street 1:1601 E BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2160
Mailing Address - Country:US
Mailing Address - Phone:954-463-3421
Mailing Address - Fax:954-463-3316
Practice Address - Street 1:1601 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2160
Practice Address - Country:US
Practice Address - Phone:954-463-3421
Practice Address - Fax:954-463-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57531207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC56932Medicare UPIN
FLFO266AMedicare PIN