# MID ATLANTIC MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386703460
- **Authorized official:** MR. RARYMOND C DEFORE (OWNER)
- **Authorized official phone:** (704) 865-9858

## Contact information

- **Practice address:** 207 S CHESTNUT ST, GASTONIA, NC 28054-7177
- **Practice address phone:** (704) 865-9858
- **Practice address fax:** (704) 865-9848
- **Mailing address:** 207 S CHESTNUT ST, GASTONIA, NC 28054-7177
- **Mailing address phone:** (704) 865-9858
- **Mailing address fax:** (704) 865-9848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | — | NULL | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 09/11/2025