Provider Demographics
NPI: | 1497987838 |
---|---|
Name: | RAZZANO, ANDREW JOSEPH JR (DO) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ANDREW |
Middle Name: | JOSEPH |
Last Name: | RAZZANO |
Suffix: | JR |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 6480 HARRISON AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45247-7961 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-354-3700 |
Mailing Address - Fax: | 513-354-7651 |
Practice Address - Street 1: | 2835 MIAMI VILLAGE DR |
Practice Address - Street 2: | |
Practice Address - City: | MIAMISBURG |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45342-4587 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-354-3700 |
Practice Address - Fax: | 513-354-7651 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-08-19 |
Last Update Date: | 2018-11-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 34.011213 | 207X00000X, 207XX0005X |
OH | 34011213 | 207XX0005X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | PENDING | Medicaid | |
OH | PENDING | Medicaid |