Healthcare Provider Details

I. General information

NPI: 1295199511
Provider Name (Legal Business Name): ROXANNA DURRANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date: 12/26/2019
Reactivation Date: 01/29/2020

III. Provider practice location address

1152 OREGONIA RD
LEBANON OH
45036-9740
US

IV. Provider business mailing address

1152 OREGONIA RD
LEBANON OH
45036-9740
US

V. Phone/Fax

Practice location:
  • Phone: 513-970-2300
  • Fax:
Mailing address:
  • Phone: 513-970-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.014462CTR
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: