Provider Demographics
NPI:1467525063
Name:SANJAY R. GANPULE, MD
Entity Type:Organization
Organization Name:SANJAY R. GANPULE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:RAMCHANDRA
Authorized Official - Last Name:GANPULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-434-0333
Mailing Address - Street 1:1310 LAS TABLAS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9737
Mailing Address - Country:US
Mailing Address - Phone:805-434-0333
Mailing Address - Fax:805-434-0893
Practice Address - Street 1:1310 LAS TABLAS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9737
Practice Address - Country:US
Practice Address - Phone:805-434-0333
Practice Address - Fax:805-434-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41572207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC52024Medicare UPIN
CAW15459Medicare ID - Type Unspecified