Provider Demographics
NPI:1760045694
Name:COLLINS, MADISON LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 N INDIAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7530
Mailing Address - Country:US
Mailing Address - Phone:561-319-4523
Mailing Address - Fax:
Practice Address - Street 1:843 N INDIAN RIVER DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7530
Practice Address - Country:US
Practice Address - Phone:561-319-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3187522084P0800X
FL1622712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry