Constantine Theoharis, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

P5484 Issued in TX

Practice address

9600 Datapoint Dr
San Antonio, TX 78229-2028

Phone

(210) 892-3700

Fax

(210) 614-4636

NPI assigned

Apr 2, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1114048899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9600 DATAPOINT DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782292028",
            "telephone_number": "210-892-3700",
            "fax_number": "210-614-4636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 DATAPOINT DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782292028",
            "telephone_number": "210-892-3700",
            "fax_number": "210-614-4636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOHARIS",
        "first_name": "CONSTANTINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301070815",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "P5484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Theiler
• Richard R Theis, PHD
• Rose Rosario Theis
• Theodora Kulesza-Galvez MD PA
• Shasta Theodore, MD
• Theophilus Agbuke
• Thera P Care LLC
• Therahealth Professionals LLC
• Therapeutic Dimensions PLLC
• Therapeutic Footwear Inc.

• Anatomic Pathology & Clinical Pathology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Anatomic Pathology & Clinical Pathology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.