Provider Demographics
NPI:1346267085
Name:VIGNERON, EUGENE ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ANTHONY
Last Name:VIGNERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4278
Mailing Address - Country:US
Mailing Address - Phone:603-423-0051
Mailing Address - Fax:
Practice Address - Street 1:14 ARMORY RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3405
Practice Address - Country:US
Practice Address - Phone:603-673-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011583Medicaid
NHRE4914Medicare ID - Type Unspecified
NH30011583Medicaid