Middle Cove is bounded to the north, east and south by Middle Harbour and to the west by Eastern Valley Way. Middle Cove shares its postcode, 2068, with the surrounding suburbs of Castlecrag and Willoughby North.

Middle Cove takes its name from its location between two coves, Castle Cove and Crag Cove. The suburb was undeveloped bushland until 1957 when Dick Dusseldorp bought most of the land from the NSW government and subdivided Middle Cove as we know it today. Dusseldorp was the founder and the largest share holder of Lend Lease, GPT and MLC. The Dusseldorp's lived in Middle Cove until the patriarch death in 2000, the house which Dusseldorp built in Middle Cove is one of the top five house designs in Australia: it is based on Frank Lloyd Wright's inspirational honeycomb house design and is a good example of Organic Architecture. In 2004 the Dusseldorp's property was sold for a record $4.5 million.

Before European settlement, this area was populated by the Aboriginal tribe Cammeraygal, which lends its name to the nearby suburb of Cammeray. Governor Phillip in a dispatch of 1790 reported: "...About the north-west part of this harbour there is a tribe which is mentioned as being very powerful, either from their numbers or the abilities of their chief. This district is called Cammerra, the head of the tribe is named Cammerragal, by which name the men of that tribe are distinguished. Of these Bands, we know more about the Cammeraygals. They are recorded as being a very powerful people and by far the most numerous. They were also the most robust and muscular and had the extraordinary privilege of extracting a tooth from the natives of other Bands and Tribes inhabiting the sea-coast."

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