Healthcare Provider Details

I. General information

NPI: 1588621668
Provider Name (Legal Business Name): MANJUSHREE MADHAV DESHPANDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 EL CAMINO REAL PALO ALTO MEDICAL FOUNDATION DEPARTMENT OF FAMILY MEDI
PALO ALTO CA
94301-2302
US

IV. Provider business mailing address

P.O. BOX 10000 PALO ALTO MEDICAL FOUNDATION
PALO ALTO CA
94303-0985
US

V. Phone/Fax

Practice location:
  • Phone: 650-321-4121
  • Fax: 415-353-3450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: