MEDICARE: ASC DEVELOPMENT COMPANY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center		MD

General Provider Information

NPI Number	:	1740529064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASC DEVELOPMENT COMPANY, LLC

Provider Business Mailing Address
First Line	:	11350 MCCORMICK RD STE 501
Second Line	:
City	:	HUNT VALLEY
State	:	MD
Zip	:	21031-1002
Country	:	US
Telephone Number	:	301-588-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	8455 COLESVILLE RD
Second Line	:	2ND FLOOR
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3315
Country	:	US
Telephone Number	:	301-588-0505
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL MEDICAL DIRECTOR
Name	:	RICHARD J BROUILLETTE
Credential	:	DO
Telephone Number	:	301-588-0505

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	04/24/2023

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