Organization
ASC DEVELOPMENT COMPANY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD J BROUILLETTE DO (REGIONAL MEDICAL DIRECTOR)
(410) 290-9191
Entity
Organization
Contact information
Practice address
7120 MINSTREL WAY, SUITE 106, COLUMBIA, MD 21045-5248
(410) 290-9191
(410) 290-7330
Mailing address
PO BOX 931606, ATLANTA, GA 31193-1606
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
589
BLUE CROSS
MD
01
—
89379501
BLUE CROSS REGIONAL PLAN
MD
01
—
P00381350
RAILROAD MEDICARE
MD
Enumeration date
09/03/2008
Last updated
06/02/2025
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