Individual
BRIAN CLANCY TULLOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
265 WESTERN AVE STE 2, SOUTH PORTLAND, ME 04106-2458
(207) 661-0200
(207) 661-0299
Mailing address
265 WESTERN AVE STE 2, SOUTH PORTLAND, ME 04106-2458
(207) 661-0200
(207) 661-0299
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2961
NH
363A00000X
Physician Assistant
Primary
PA2930
ME
363A00000X
Physician Assistant
—
—
Other
Enumeration date
11/29/2022
Last updated
09/03/2025
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