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General NPI Number Information
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NPI Number | 1407004534
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Entity Type | Organization
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Legal Business Name | ASC DEVELOPMENT COMPANY, LLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 7120 MINSTREL WAY SUITE 106
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City | COLUMBIA
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State | MD
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Zip | 21045-5248
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Country | US
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Telephone | 410-290-9191
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Fax | 410-290-7330
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Provider Business Mailing Address
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Address Line | PO BOX 931606
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City | ATLANTA
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State | GA
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Zip | 31193-1606
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGIONAL MEDICAL DIRECTOR
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Name | RICHARD J BROUILLETTE
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Credential | DO
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Telephone | 410-290-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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