Active NPI
Brian Clancy Tulloh, PA-C
- Physician Assistant
- South Portland, ME
National Provider Identifier
1972213148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2930
- Practice address
- 265 Western Ave Ste 2
South Portland, ME 04106-2458 - Phone
- (207) 661-0200
- Fax
- (207) 661-0299
- NPI assigned
- Nov 29, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2930 | ME | Primary |
| Physician Assistant | 363A00000X | 2961 | NH | |
| Physician Assistant | 363A00000X |
Addresses
Primary practice location
265 Western Ave Ste 2
South Portland, ME 04106-2458
Mailing address
265 Western Ave Ste 2
South Portland, ME 04106-2458
Phone (207) 661-0200
Other practice location 1
1 Medical Center Dr
Lebanon, NH 03756-0001
Phone (603) 650-5000
Other practice location 2
450 Brookline Ave
Boston, MA 02215-5418
Phone (617) 632-4524
Other practice location 3
27 Industrial Ave Ste 101
Sanford, ME 04073-5846
Phone (207) 459-1666
Other practice location 4
3073 White Mountain Hwy
North Conway, NH 03860-7101
Phone (603) 356-4904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA, NH, ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 3
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
100 Campus Dr
Scarborough, ME 04074-7172
22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905
265 Western Ave
Suite 2
South Portland, ME 04106-2458
Phone (207) 396-7606
Hospital & facility affiliations
- Mainehealth Maine Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2961 | NH | MD | Pharmacist |
| PA2930 | ME | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mainehealth | Current | Accepting new patients | |
| Dartmouth-Hitchcock Clinic | Current | Accepting new patients | |
| Dana-Farber Cancer Institute, Inc. | Current | Accepting new patients | |
| Mary Hitchcock Memorial Hospital | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| Dana-Farber Cancer Institute, Inc. | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| Memorial Hospital | Current | Accepting new patients | |
| Memorial Hospital | Current | Accepting new patients | |
| Mary Hitchcock Memorial Hospital | Current | Accepting new patients | |
| Memorial Hospital | Current | Accepting new patients | |
| Dartmouth-Hitchcock Clinic | Current | Accepting new patients |
Locations
450 Brookline Ave
Boston, MA 02215
Phone (508) 478-2061
22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179
27 Industrial Ave
Ste 101
Sanford, ME 04073
Phone (207) 459-1666
265 Western Ave
Ste 2
South Portland, ME 04106
Phone (207) 661-0200
1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922
3073 White Mountain Hwy
North Conway, NH 03860
Phone (603) 356-5472
Organizations & group practices 13
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatric Hospital
- Westbrook, ME
- NPI 1790265502
-
- Special Hospital
- Boston, MA
- NPI 1346433257
-
- Internal Medicine Physician
- Lebanon, NH
- NPI 1548210198
-
- Critical Access Hospital
- North Conway, NH
- NPI 1700864709
-
- General Acute Care Hospital
- Lebanon, NH
- NPI 1023092053
-
- Community/Retail Pharmacy
- Portland, ME
- NPI 1013868181
-
- General Acute Care Hospital
- Scarborough, ME
- NPI 1053647024
-
- Durable Medical Equipment & Medical Supplies
- Chestnut Hill, MA
- NPI 1497429237
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Keene, NH
- NPI 1174176861
-
- General Acute Care Hospital
- Lebanon, NH
- NPI 1629788237
-
- Psychiatric Hospital
- Hampstead, NH
- NPI 1699584219
-
- Medicare Defined Swing Bed Hospital Unit
- North Conway, NH
- NPI 1942361985
Hospital & facility affiliations 36
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Scarborough, ME
- NPI 1053647024
-
- General Acute Care Hospital
- Portland, ME
- NPI 1346267879
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756857600000",
"number": "1972213148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "265 WESTERN AVE STE 2",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041062458",
"telephone_number": "207-661-0200",
"fax_number": "207-661-0299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "265 WESTERN AVE STE 2",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041062458",
"telephone_number": "207-661-0200",
"fax_number": "207-661-0299"
}
],
"practiceLocations": [
{
"address_1": "1 Medical Center Dr",
"address_purpose": "LOCATION",
"city": "Lebanon",
"state": "NH",
"postal_code": "037560001",
"country_code": "US",
"telephone_number": "603-650-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "450 Brookline Ave",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "022155418",
"country_code": "US",
"telephone_number": "617-632-4524",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "27 Industrial Ave Ste 101",
"address_purpose": "LOCATION",
"city": "Sanford",
"state": "ME",
"postal_code": "040735846",
"country_code": "US",
"telephone_number": "207-459-1666",
"fax_number": "207-661-8537",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3073 White Mountain Hwy",
"address_purpose": "LOCATION",
"city": "North Conway",
"state": "NH",
"postal_code": "038607101",
"country_code": "US",
"telephone_number": "603-356-4904",
"fax_number": "603-356-0842",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TULLOH",
"first_name": "BRIAN",
"middle_name": "CLANCY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-29",
"last_updated": "2025-09-03",
"certification_date": "2025-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ME",
"license": "PA2930",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NH",
"license": "2961",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.