Individual provider Active NPI

Rajendra Gajula, MD

  • Psychiatry Physician
  • Dallas, PA
National Provider Identifier
1124011614
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD047327L Issued in PA
Practice address
46 Westminster Dr
Dallas, PA 18612-1415
Phone
(570) 675-0758
NPI assigned
Aug 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD047327L PA Primary

Addresses

Primary practice location

46 Westminster Dr
Dallas, PA 18612-1415

Mailing address

46 Westminster Dr
Dallas, PA 18612-1415
Phone (570) 675-0758

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060120000561 PA Practitioner - Psychiatry 6608890397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Counseling ServicesGroup PAC ID 5799768115, 10 clinicians

Practice addresses (Care Compare)

750 E Broad St
Hazelton, PA 18201-6835
Phone (570) 455-6385

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD047327LPAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Counseling Services CurrentSince Aug 20, 1992 Accepting new patients
Omni Health Services, Inc. Psychiatry PastSince Nov 13, 2019 Accepting new patients
Pennsylvania Department of Human Services Past Accepting new patients

Locations

750 E Broad St
Hazleton, PA 18201

121 S Prospect St
Nanticoke, PA 18634
Phone 5704556385 ext. 255

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1124011614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 WESTMINSTER DR",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186121415",
            "telephone_number": "570-675-0758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 WESTMINSTER DR",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186121415",
            "telephone_number": "570-675-0758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAJULA",
        "first_name": "RAJENDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD047327L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, PA

Sources for this page

Verify at the official NPI Registry.