Healthcare Provider Details

I. General information

NPI: 1104756535
Provider Name (Legal Business Name): JITHIN TEJA KOLLI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHARLESTON AREA MEDICAL CENTER, 3200 MACCORKLE AVE, SE.
CHARLESTON WV
25304
US

IV. Provider business mailing address

CHARLESTON AREA MEDICAL CENTER, 3200 MACCORKLE AVE, SE.
CHARLESTON WV
25304
US

V. Phone/Fax

Practice location:
  • Phone: 304-351-2869
  • Fax: 304-388-8238
Mailing address:
  • Phone: 304-351-2869
  • Fax: 304-388-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: