Provider Demographics
NPI:1225027337
Name:HENRY, CYNTHIA LAVERY (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LAVERY
Last Name:HENRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:2535 HALE ST
Practice Address - Street 2:SUITE A
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1856
Practice Address - Country:US
Practice Address - Phone:440-934-8810
Practice Address - Fax:440-934-8811
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34008695207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2625243Medicaid
OH2625243Medicaid
OH4175641Medicare PIN
OH4175642Medicare PIN