MEDICARE: DR. PAUL ALFRED VIGNOLA M.D.

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	207RC0000X	Cardiovascular Disease Physician	ME31676	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00717543	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750383329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ALFRED VIGNOLA M.D.

Provider Business Mailing Address
First Line	:	175 MARY ST
Second Line	:
City	:	BOONE
State	:	NC
Zip	:	28607-5025
Country	:	US
Telephone Number	:	828-264-9664
Fax Number	:	786-428-1062

Provider Business Practice Location Address
First Line	:	21097 NE 27TH CT
Second Line	:	SUITE 350
City	:	AVENTURA
State	:	FL
Zip	:	33180-1204
Country	:	US
Telephone Number	:	786-428-1059
Fax Number	:	786-428-1062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	09/26/2013

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