Healthcare Provider Details

I. General information

NPI: 1588962831
Provider Name (Legal Business Name): ASC DEVELOPMENT COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 OLD WASHINGTON RD STE 300
WALDORF MD
20602-3240
US

IV. Provider business mailing address

PO BOX 931606
ATLANTA GA
31193-1606
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-1523
  • Fax: 301-645-6812
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD J BROUILLETTE
Title or Position: REGIONAL MEDICAL DIRECTOR
Credential: DO
Phone: 301-645-1523