Provider Demographics
NPI:1457774788
Name:RAVICHANDRAN-CUPP, YAGNARAM PICHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:YAGNARAM
Middle Name:PICHAI
Last Name:RAVICHANDRAN-CUPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YAGNARAM
Other - Middle Name:
Other - Last Name:RAVICHANDRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7727 PLATINI PLACE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214
Mailing Address - Country:US
Mailing Address - Phone:347-741-9680
Mailing Address - Fax:
Practice Address - Street 1:PEYTON MANNING CHILDREN'S HOSPITAL, ASCENSION ST.
Practice Address - Street 2:VINCENT INDIANAPOLIS 2001 W 86TH STREET
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1902
Practice Address - Country:US
Practice Address - Phone:317-238-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU04262080P0204X
IAMD495462080P0204X
WVMD313672080P0204X
CAA1834902080P0204X
MI43011095172080P0204X
OH35.1333212080P0204X
IN01088537A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0343550Medicaid