Basic Information
| Provider Information | |||||||||
| NPI: | 1023266145 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASC DEVELOPMENT COMPANY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 CRAIN HWY S | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210615577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107878315 | ||||||||
| FaxNumber: | 4107878316 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 CRAIN HWY S | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210615577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107878315 | ||||||||
| FaxNumber: | 4107878316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | ANISH | ||||||||
| AuthorizedOfficialMiddleName: | SHARAD | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3016200012 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | P00081013 | 01 | MD | RAILROAD MEDICARE | OTHER | CN932 | 01 | MD | RAILROAD MEDICARE | OTHER | RM6 | 01 | MD | BLUE CROSS REGIONAL PLAN | OTHER | L7 | 01 | MD | BLUE CROSS | OTHER |