Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Anthony C Theodoris, MD

Individual provider Pulmonary Disease Physician · NPI 1578675971

Dr. Anthony C Theodoris, MD is a Pulmonary Disease in Port Jefferson Station, New York. Qualified in 1998, 28 years ago. Practices with Stony Brook Internists University Faculty Practice Corporation, a 428-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
28
Licensed in
NY
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8054
Phone: (631) 978-7633
Fax: (631) 638-4884
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pulmonary Disease Physician (primary) Taxonomy 207RP1001X · Licence 221756-1 (NY)

Record details

NPI number1578675971
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 31, 2006
Last updated in NPPESApril 29, 2022
Certification dateApril 29, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPULMONARY DISEASE
Also practisesCRITICAL CARE (INTENSIVISTS)
Medical schoolOTHER
Graduated 1998 (28 years in practice)
Group practice Stony Brook Internists University Faculty Practice Corporation — 428 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Port Jefferson Station