Provider Demographics
NPI:1750383329
Name:VIGNOLA, PAUL ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALFRED
Last Name:VIGNOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:175 MARY ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5025
Mailing Address - Country:US
Mailing Address - Phone:828-264-9664
Mailing Address - Fax:786-428-1062
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 350
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:786-428-1059
Practice Address - Fax:786-428-1062
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME31676207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064486200Medicaid
FLP00717543OtherRR MEDICARE
FL79486YMedicare PIN
FL064486200Medicaid
A53903Medicare UPIN