Healthcare Provider Details

I. General information

NPI: 1093248023
Provider Name (Legal Business Name): FABRICE BYRON HENRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # NA-23
CLEVELAND OH
44195-2432
US

IV. Provider business mailing address

9500 EUCLID AVE # NA-23
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 330-888-0452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.145095
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: