MEDICARE: MARK BERNHARDT, MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	57531	FL

General Provider Information

NPI Number	:	1801827761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK BERNHARDT, MD, PA

Provider Business Mailing Address
First Line	:	1601 E BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2160
Country	:	US
Telephone Number	:	954-463-3421
Fax Number	:	954-463-3316

Provider Business Practice Location Address
First Line	:	1601 E BROWARD BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2160
Country	:	US
Telephone Number	:	954-463-3421
Fax Number	:	954-463-3316

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK BERNHARDT
Credential	:	M.D.
Telephone Number	:	954-463-3421

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/17/2012

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