Healthcare Provider Details

I. General information

NPI: 1568621142
Provider Name (Legal Business Name): VARSHA R PATHAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 EASTBROOK DR STE 100
FORT COLLINS CO
80525-5744
US

IV. Provider business mailing address

430 N COLLEGE AVE STE 470
FORT COLLINS CO
80524-2678
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-7733
  • Fax: 970-493-8745
Mailing address:
  • Phone: 970-212-5367
  • Fax: 970-212-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD451560
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDR.0059541
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102941013
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierDR.0059541
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerCO LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: