MEDICARE: SEACOAST PLASTIC SURGERY AND MEDICAL AESTHETICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1134992704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEACOAST PLASTIC SURGERY AND MEDICAL AESTHETICS, PLLC

Provider Business Mailing Address
First Line	:	100 BORTHWICK AVE STE 220
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4115
Country	:	US
Telephone Number	:	603-956-6059
Fax Number	:	603-956-6091

Provider Business Practice Location Address
First Line	:	100 BORTHWICK AVE STE 220
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4115
Country	:	US
Telephone Number	:	603-956-6059
Fax Number	:	603-956-6091

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDER H SLOCUM
Credential	:	MD
Telephone Number	:	603-799-6787

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	04/20/2026

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