Provider Demographics
NPI:1184719213
Name:GAJULA, LAKSHMINARAYANA (MD)
Entity type:Individual
Prefix:DR
First Name:LAKSHMINARAYANA
Middle Name:
Last Name:GAJULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.NARAYANA
Other - Middle Name:
Other - Last Name:GAJULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-862-3295
Mailing Address - Fax:846-644-7659
Practice Address - Street 1:281 N 12TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1101
Practice Address - Country:US
Practice Address - Phone:610-377-6969
Practice Address - Fax:610-377-9099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022461E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000571402Medicaid