Provider Demographics
NPI:1588621668
Name:DESHPANDE, MANJUSHREE MADHAV (MD)
Entity Type:Individual
Prefix:MRS
First Name:MANJUSHREE
Middle Name:MADHAV
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:P.O. BOX 10000
Mailing Address - Street 2:PALO ALTO MEDICAL FOUNDATION
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-0985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:795 EL CAMINO REAL
Practice Address - Street 2:PALO ALTO MEDICAL FOUNDATION DEPARTMENT OF FAMILY MEDI
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2302
Practice Address - Country:US
Practice Address - Phone:650-321-4121
Practice Address - Fax:415-353-3450
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2022-02-11
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Provider Licenses
StateLicense IDTaxonomies
CAA91105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A911050Medicaid
CA00A911050Medicare PIN
CA00A911050Medicaid