Provider Demographics
NPI:1205455482
Name:TOPALIS, KATHRYN MARY
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARY
Last Name:TOPALIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WINTERSET LN
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1720
Mailing Address - Country:US
Mailing Address - Phone:860-888-2728
Mailing Address - Fax:
Practice Address - Street 1:797 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2617
Practice Address - Country:US
Practice Address - Phone:626-795-2244
Practice Address - Fax:626-795-5378
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA186641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine