Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 GREENLAND RD UNIT C8
PORTSMOUTH NH
03801-4163
US

IV. Provider business mailing address

875 GREENLAND RD UNIT C8
PORTSMOUTH NH
03801-4163
US

V. Phone/Fax

Practice location:
  • Phone: 603-956-6059
  • Fax: 603-956-6091
Mailing address:
  • Phone: 603-956-6059
  • Fax: 603-956-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER H SLOCUM
Title or Position: OWNER
Credential: MD
Phone: 603-799-6787