Provider Demographics
NPI:1588605463
Name:RACK, SARAH KOTCHEN (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:KOTCHEN
Last Name:RACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5200
Mailing Address - Country:US
Mailing Address - Phone:901-765-3409
Mailing Address - Fax:901-765-3343
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5200
Practice Address - Country:US
Practice Address - Phone:901-765-3409
Practice Address - Fax:901-765-3343
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS177062084P0800X
TN472082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS260051193OtherPALMETTO GBA-RAILROAD MED
MS00126103Medicaid
MSH10268Medicare UPIN
MS00126103Medicaid