Provider Demographics
NPI:1326110156
Name:GANPULE, NANDINI L (MD)
Entity Type:Individual
Prefix:
First Name:NANDINI
Middle Name:L
Last Name:GANPULE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHANDRALEKHA
Other - Middle Name:
Other - Last Name:GANDHYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1950 ALAMEDA DE LAS PULGAS # 157
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1222
Mailing Address - Country:US
Mailing Address - Phone:650-573-3571
Mailing Address - Fax:
Practice Address - Street 1:1950 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1222
Practice Address - Country:US
Practice Address - Phone:650-573-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA330302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A330300Medicaid
00A330300Medicare ID - Type Unspecified
CA00A330300Medicaid