Provider Demographics
NPI:1659398360
Name:PATWARDHAN, MANJUL C (MD)
Entity Type:Individual
Prefix:
First Name:MANJUL
Middle Name:C
Last Name:PATWARDHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANJUL
Other - Middle Name:
Other - Last Name:MAHASHABDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:898 PERSIMMON AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1819
Mailing Address - Country:US
Mailing Address - Phone:408-219-3130
Mailing Address - Fax:408-725-0777
Practice Address - Street 1:10353 TORRE AVE
Practice Address - Street 2:STE A
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3217
Practice Address - Country:US
Practice Address - Phone:408-725-1777
Practice Address - Fax:408-725-0777
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691820Medicare ID - Type UnspecifiedMEDICARE
CAH29284Medicare UPIN