Healthcare Provider Details

I. General information

NPI: 1346267085
Provider Name (Legal Business Name): EUGENE ANTHONY VIGNERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ARMORY RD
MILFORD NH
03055-3405
US

IV. Provider business mailing address

19 CAMBRIDGE DR
MERRIMACK NH
03054-4278
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-2515
  • Fax:
Mailing address:
  • Phone: 603-423-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10407
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: