Healthcare Provider Details

I. General information

NPI: 1750383329
Provider Name (Legal Business Name): PAUL ALFRED VIGNOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21097 NE 27TH CT SUITE 350
AVENTURA FL
33180-1204
US

IV. Provider business mailing address

175 MARY ST
BOONE NC
28607-5025
US

V. Phone/Fax

Practice location:
  • Phone: 786-428-1059
  • Fax: 786-428-1062
Mailing address:
  • Phone: 828-264-9664
  • Fax: 786-428-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME31676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: