MEDICARE: DERIVE HEALTH, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1013860675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERIVE HEALTH, PA

Provider Business Mailing Address
First Line	:	2230 PARK RD STE 105
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6664
Country	:	US
Telephone Number	:	980-221-2689
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 PARK RD STE 105
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6664
Country	:	US
Telephone Number	:	980-221-2689
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JONATHAN A LEAKE
Credential	:	MD
Telephone Number	:	980-221-2689

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “DERIVE HEALTH, PA ” Practice Location

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