Provider Demographics
NPI:1366878787
Name:COLLINS, MADISON (PA-C)
Entity type:Individual
Prefix:MS
First Name:MADISON
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:STEWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1910 SASSAFRAS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2716
Mailing Address - Country:US
Mailing Address - Phone:814-452-2767
Mailing Address - Fax:814-452-7919
Practice Address - Street 1:2315 MYRTLE ST
Practice Address - Street 2:STE 290
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4602
Practice Address - Country:US
Practice Address - Phone:814-452-2767
Practice Address - Fax:814-452-7919
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATMA052864363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical