Provider Demographics
NPI:1437173085
Name:GANPULE, SANJAY RAMCHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:RAMCHANDRA
Last Name:GANPULE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:325 POSADA LN
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4003
Practice Address - Country:US
Practice Address - Phone:805-434-1038
Practice Address - Fax:805-434-5932
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA41572207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70936FMedicaid
CAFHC70936FMedicaid
CA551907Medicare Oscar/Certification
CAW1508AMedicare PIN