| Middle Ridge | E Mitchell County between Little Rock Creek and Green Creek. |
| Middle Ridge | E Swain County between Improvement Creek and Wesser Creek. |
| Middle Ridge | S Yancey County between Middle Creek and Colbert Creek. |
| Middle Ridge Branch | rises in SE Mitchell County and flows S into Dicks Creek. |
| Middle River | rises in SE Bertie County and flows NE into Cashie River. Named for the fact that along much of its course, it lies midway between Roanoke and Cashie Rivers. |
| Middle Sound | E New Hanover County between Topsail sound on the N and Greenville Sound on the s. |
| Middle Swamp | rises in S central Bladen County and flows S and W into Elkton Swamp. |
| Middle Swamp | rises in SE Brunswick County and flows SW into Lockwoods Folly River. |
| Middle Swamp | rises in N Gates County and flows E into Duke Swamp. |
| Middle Swamp | rises in N Greene County and flows SE on the Greene-Pitt county line into Little Contentnea Creek. |