Individual ProviderManohar GajjelaInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address11109 Parkview Plaza Dr, Fort Wayne, IN 46845(606) 726-6620PECOS EnrollmentBased on the most recent information from CMS, provider Manohar Gajjela is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1942594106Provider TypeIndividualFull NameGajjela, ManoharCredentialMDGenderMaleSole ProprietorYesEnumeration Date6/6/2011Last Updated10/12/2022Contact InformationPractice LocationPractice Address11109 Parkview Plaza Dr, Fort Wayne, IN 46845Phone(606) 726-6620Fax(260) 672-6639Mailing LocationMailing Address11109 Parkview Plaza Dr # 117, Fort Wayne, IN 46845-1701PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense01081675AIndianaCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicense77792MarylandCode282N00000XDescriptionGeneral Acute Care HospitalHospitalsLicense77792Maryland