Organization
MID ATLANTIC MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RARYMOND C DEFORE (OWNER)
(704) 865-9858
Entity
Organization
Contact information
Practice address
207 S CHESTNUT ST, GASTONIA, NC 28054-7177
(704) 865-9858
(704) 865-9848
Mailing address
207 S CHESTNUT ST, GASTONIA, NC 28054-7177
(704) 865-9858
(704) 865-9848
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7704261
—
NC
Enumeration date
12/06/2006
Last updated
09/11/2025
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