Provider Demographics
NPI:1548349533
Name:MEDLICOTT, ALEX G (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:G
Last Name:MEDLICOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOSPITAL ROAD, SPEARE MEMORIAL HOSPITAL
Mailing Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 HOSPITAL ROAD, SPEARE MEMORIAL HOSPITAL
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264
Practice Address - Country:US
Practice Address - Phone:603-536-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6137207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH6137OtherSTATE LICENSE
AM2737774OtherDEA CERTIFICATE
NH6137OtherSTATE LICENSE