Provider Demographics
NPI:1295199511
Name:DURRANI, ROXANNA
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:DURRANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 OREGONIA RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9740
Mailing Address - Country:US
Mailing Address - Phone:513-970-2300
Mailing Address - Fax:
Practice Address - Street 1:1152 OREGONIA RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9740
Practice Address - Country:US
Practice Address - Phone:513-970-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2021-08-04
Deactivation Date:2019-12-26
Deactivation Code:
Reactivation Date:2020-01-29
Provider Licenses
StateLicense IDTaxonomies
OH34.014462CTR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine